Lopez R R, Benner K G, Hall L, Rösch J, Pinson C W
Department of Surgery, Oregon Health Sciences University and Surgical Service, Veterans Affairs Medical Center, Portland.
Gastroenterology. 1991 May;100(5 Pt 1):1435-41.
The goals of treatment of the Budd-Chiari syndrome are relief of portal hypertension, relief of inferior vena cava syndrome, if present, and preservation of hepatic function. This study presents a patient with clinical resolution of the Budd-Chiari syndrome after placement of expandable metallic stents in the inferior vena cava and hepatic veins. A 26-year-old man with severe ascites and lower extremity edema but with relatively preserved hepatic function had a small gradient across a suprahepatic caval web, large gradients across an intrahepatic caval stenosis and the left hepatic vein, and an occluded right hepatic vein. Under angiographic control, web and caval stenosis were balloon-dilated, and modified Gianturco expandable metallic stents were placed in the intrahepatic vena cava. The left hepatic vein was dilated twice and a stent was placed. All gradients were completely eliminated. There were no complications and after 1 year, the stents have fully expanded without migration, edema and ascites have resolved, hepatic function has normalized, and the patient has returned to work. This new technique provides a simple, safe, effective, relatively inexpensive, and potentially long-lasting treatment for selected patients with the Budd-Chiari syndrome.
布加综合征的治疗目标是缓解门静脉高压，若存在下腔静脉综合征则予以缓解，并保留肝功能。本研究介绍了一名患者，在其下腔静脉和肝静脉置入可扩张金属支架后，布加综合征获得临床缓解。一名26岁男性，有严重腹水和下肢水肿，但肝功能相对保留，肝上腔静脉蹼压差小，肝内腔静脉狭窄及左肝静脉压差大，右肝静脉闭塞。在血管造影控制下，对蹼和腔静脉狭窄进行球囊扩张，并在肝内静脉置入改良的朱安可可扩张金属支架。左肝静脉扩张两次并置入一枚支架。所有压差完全消除。无并发症发生，1年后，支架完全扩张且未移位，水肿和腹水消退，肝功能恢复正常，患者已重返工作岗位。这项新技术为部分布加综合征患者提供了一种简单、安全、有效、相对廉价且可能持久的治疗方法。
