Griffith J F, Mahmoud A E, Cooper S, Elias E, West R J, Olliff S P
Department of Clinical Radiology, Queen Elizabeth Hospital, Birmingham, UK.
Clin Radiol. 1996 Nov;51(11):775-84. doi: 10.1016/s0009-9260(96)80005-5.
We reviewed our experience of the therapeutic role of radiology in Budd-Chiari syndrome. Patients with stenosis and/or occlusion of the main hepatic veins and/or inferior vena cava (IVC) are suitable for radiological intervention (35% in our series). Eighteen patients (mean age 37.4 years) have undergone radiological intervention over the past 8 years. The site of obstruction was the hepatic veins in 12/18 patients while 6/18 patients had both hepatic vein and IVC obstruction, which in two was due to tumour thrombus. One patient had repeated dilatations of a mesocaval shunt; 49 angiographic venous dilatations were performed (18 during initial intervention, 31 on review) including 10 recanalizations of occlusions. A combined transhepatic-transjugular approach was used for 10/49 procedures. Thrombolysis was performed in 5/18 and stent insertion in 6/18 patients. Three serious complications occurred (IVC stent migration, hepatic artery pseudoaneurysm, myocardial puncture). Follow-up, after initial intervention, has continued for a mean of 24.2 months (range 4 days-92 months). Symptoms related to hepatic venous outflow obstruction were fully relieved in 10/18 (56%) patients and partially relieved in 4/18 (22%) patients. Close monitoring (and re-intervention) during the early post-intervention period is needed because 28% of initial venous dilatations failed to provide adequate venous return in the first instance. Once the patient is stabilized regular review is mandatory as HV restenosis is common after 10 months or more follow-up. The efficacy and safety of radiological intervention make it the preferred first line of treatment in selected patients with Budd-Chiari syndrome.
我们回顾了放射学在布加综合征治疗中的作用。主要肝静脉和/或下腔静脉狭窄和/或闭塞的患者适合进行放射学干预（在我们的系列研究中占35%）。在过去8年中，18例患者（平均年龄37.4岁）接受了放射学干预。18例患者中，12例的梗阻部位为肝静脉，6例同时存在肝静脉和下腔静脉梗阻，其中2例是由于肿瘤血栓所致。1例患者的肠系膜上腔静脉分流术反复扩张；共进行了49次血管造影静脉扩张术（初始干预时18次，复查时31次），包括10次闭塞再通术。49次手术中有10次采用了经肝-经颈静脉联合入路。18例患者中有5例进行了溶栓治疗，6例进行了支架置入。发生了3例严重并发症（下腔静脉支架移位、肝动脉假性动脉瘤、心肌穿刺）。初始干预后的随访平均持续了24.2个月（范围4天至92个月）。18例患者中有10例（56%）与肝静脉流出道梗阻相关的症状完全缓解，4例（22%）部分缓解。在干预后的早期需要密切监测（并再次干预），因为28%的初始静脉扩张术在最初未能提供足够的静脉回流。一旦患者病情稳定，定期复查是必需的，因为在随访10个月或更长时间后肝静脉再狭窄很常见。放射学干预的有效性和安全性使其成为布加综合征特定患者首选的一线治疗方法。
