Wu Xing-jiang, Cao Jian-min, Han Jian-ming, Li Jie-shou
Research Institute of General Surgery, Nanjing General Hospital of Nanjing Command, Nanjing 210002, China.
Zhonghua Wai Ke Za Zhi. 2013 Feb 1;51(2):131-4.
To determine the outcome of hepatic venousaplasty and transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of the Budd-Chiari syndrome with occlusion of the hepatic veins.
Fifty patients of the Budd-Chiari syndrome with occlusion of the hepatic veins (23 males and 27 females, with a mean age of (39 ± 11) years) were elected for venousaplasty or TIPS. The average of Child-Pugh scores was 9.6 ± 2.6. Three patients had a acute course of the disease, while 47 patients had a subacute or a chronic course of the disease. The clinical presentation was ascites in all 50 cases, with concomitant upper gastrointestinal bleeding in 10 patients, hepatorenal syndrome in 4 patients and impaired liver function in all patients. Hepatic venousplasty was performed for 12 patients with occlusion of hepatic venous. Hepatic and inferior caval venousplasty were performed for 6 patients with occlusion of hepatic and inferior caval vein. TIPS was performed for 13 patients with occlusion of small hepatic vein. Modified TIPS was performed for 19 patients with extensive occlusion of hepatic vein.
The procedure of treatment was successfully performed in all patients. The shunt reduced the portosystemic pressure gradient from (41 ± 10) to (27 ± 6) cmH2O (1 cmH2O = 0.098 kPa, t = 20.20, P = 0.001) and improved the portal flow velocity from (14 ± 10) to (52 ± 14) cm/s (t = 15.02, P = 0.001) after TIPS or modified TIPS. Clinical symptoms and the biochemical test results improved significantly during 3 weeks after hepatic venousplasty and shunt treatment. During the hospitalization, the death occurred in 1 case due to hepatic failure and the acute occlusion of shunt was treated with secondary intervention in another case. The mean follow-up was (82 ± 46) months. The revisions of shunt with TIPS were needed in 2 patients and the inflation of stenosised hepatic vein in another 2 patients during the follow-up. All patients were still observed.
Hepatic venousaplasty and TIPS provide an excellent outcome in patients of Budd-Chiari syndrome with occlusion of the hepatic veins.
确定肝静脉成形术和经颈静脉肝内门体分流术（TIPS）治疗肝静脉闭塞型布加综合征的疗效。
选取50例肝静脉闭塞型布加综合征患者（男23例，女27例，平均年龄(39±11)岁）行静脉成形术或TIPS。Child-Pugh评分平均为9.6±2.6。3例为急性病程，47例为亚急性或慢性病程。50例患者临床表现均为腹水，10例伴有上消化道出血，4例合并肝肾综合征，所有患者均有肝功能损害。12例肝静脉闭塞患者行肝静脉成形术。6例肝静脉和下腔静脉闭塞患者行肝静脉和下腔静脉成形术。13例小肝静脉闭塞患者行TIPS。19例肝静脉广泛闭塞患者行改良TIPS。
所有患者治疗过程均顺利完成。TIPS或改良TIPS术后，分流使门体压力梯度从(41±10)降至(27±6) cmH2O（1 cmH2O = 0.098 kPa，t = 20.20，P = 0.001），门静脉血流速度从(14±10)提高至(52±14) cm/s（t = 15.02，P = 0.001）。肝静脉成形术和分流治疗后3周内临床症状和生化检查结果明显改善。住院期间，1例因肝功能衰竭死亡，另1例分流急性闭塞经二次干预治疗。平均随访(82±46)个月。随访期间，2例患者需要行TIPS分流修正术，另2例患者肝静脉狭窄处需要球囊扩张。所有患者仍在观察中。
肝静脉成形术和TIPS治疗肝静脉闭塞型布加综合征患者疗效良好。
