Panagiotou I, Kelekis D A, Karatza C, Nikolaou V, Mouyia V, Brountzos E N
2nd Department of Radiology, Athens University School of Medicine, Attikon University Hospital Athens, Greece.
Hepatogastroenterology. 2007 Sep;54(78):1813-6.
Patients with Budd-Chiari syndrome may require therapy with portal decompressive surgery. Transjugular intrahepatic portosystemic shunt has recently emerged as a new treatment alternative to surgical shunting, but reported literature is scarce and its long-term outcome is to be evaluated. The aim of our study was to present two patients with Budd-Chiari syndrome treated with transjugular intrahepatic portosystemic shunt. Two female patients with acute and subacute Budd-Chiari syndrome respectively, uncontrolled by medical therapy, were referred for transjugular intrahepatic portosystemic shunting. Both patients had refractory ascites, while one had hepatic insufficiency. Hepatic vein thrombosis was without definitive etiology in one patient and due to essential thrombocytosis in the other. Transjugular intrahepatic portosystemic shunt was successfully created in both patients; in one a transcaval approach was performed. Bare stents were used in one, while in the other a polytetrafluoroethylene-covered stent-graft. Technical success was 100% with no complications. Ascites resolved in both patients and liver function improved. The first patient remains asymptomatic with good shunt patency 6 months after intervention. The second patient is symptom-free two years after the shunt creation, despite stent occlusion. She remains asymptomatic due to hepatic vein collateral development. In patients with acute or subacute Budd-Chiari syndrome uncontrolled by medical therapy, transjugular intrahepatic portosystemic shunt is highly effective with no complications and an associated mid-term clinical success.
布加综合征患者可能需要进行门脉减压手术治疗。经颈静脉肝内门体分流术最近已成为手术分流的一种新的治疗选择，但相关报道的文献较少，其长期疗效有待评估。我们研究的目的是介绍两例接受经颈静脉肝内门体分流术治疗的布加综合征患者。两名女性患者分别患有急性和亚急性布加综合征，药物治疗无效，被转诊接受经颈静脉肝内门体分流术。两名患者均有难治性腹水，其中一名患者有肝功能不全。一名患者肝静脉血栓形成病因不明，另一名患者是由于原发性血小板增多症。两名患者均成功进行了经颈静脉肝内门体分流术；其中一名采用经腔静脉途径。一名患者使用裸支架，另一名患者使用聚四氟乙烯覆膜支架移植物。技术成功率为100%，无并发症。两名患者的腹水均消退，肝功能改善。第一名患者在干预后6个月无症状，分流通畅良好。第二名患者在分流术后两年无症状，尽管支架闭塞。由于肝静脉侧支循环形成，她仍然无症状。对于药物治疗无效的急性或亚急性布加综合征患者，经颈静脉肝内门体分流术非常有效，无并发症，且具有中期临床成功率。
