CAJ | 학술논문

目的探讨下腔静脉全程闭塞介入治疗的安全性及疗效.方法回顾性分析6例经彩色多普勒超声及DSA确诊的下腔静脉全程闭塞患者资料.全部患者均于局部麻醉下经颈静脉联合经股静脉途径行肝静脉、下腔静脉造影及球囊扩张和(或)支架置入术,测量介入治疗前后肝静脉-右心房压力差及下腔静脉-右心房压力差,并观察术后疗效和并发症.术后1、3、6、12个月及此后每间隔12个月行彩色多普勒超声随访,观察血管通畅情况.治疗前后肝静脉-右心房压力差及下腔静脉-右心房压力差的比较采用配对￡检验.结果 6例患者中,5例均成功开通1支肝静脉及下腔静脉；1例下腔静脉开通失败,仅开通肝右静脉.6例肝静脉-右心房压力差由术前的(23.2±2.0)cmH2O(1 cmH2O =0.098 kPa)降至术后的(8.7 ±3.2) cmH2O,5例下腔静脉-右心房压力差由术前的(26.6±2.7)cmH2O降至术后的(9.4±1.1) cmH2O,差异均有统计学意义(t值分别为21.6和16.1,P ＜0.05).3例患者术后出现轻度刺激性腹痛,24 h内缓解,无出血、死亡等并发症.6例患者随访16 ～ 90个月,平均(42±27)个月,均无肝静脉再狭窄,5例患者下腔静脉均通畅,无再狭窄.结论下腔静脉全程闭塞的介入治疗安全、有效.
목적 탐토하강정맥전정폐새개입치료적안전성급료효.방법 회고성분석6례경채색다보륵초성급DSA학진적하강정맥전정폐새환자자료.전부환자균우국부마취하경경정맥연합경고정맥도경행간정맥、하강정맥조영급구낭확장화(혹)지가치입술,측량개입치료전후간정맥-우심방압력차급하강정맥-우심방압력차,병관찰술후료효화병발증.술후1、3、6、12개월급차후매간격12개월행채색다보륵초성수방,관찰혈관통창정황.치료전후간정맥-우심방압력차급하강정맥-우심방압력차적비교채용배대￡검험.결과 6례환자중,5례균성공개통1지간정맥급하강정맥；1례하강정맥개통실패,부개통간우정맥.6례간정맥-우심방압력차유술전적(23.2±2.0)cmH2O(1 cmH2O =0.098 kPa)강지술후적(8.7 ±3.2) cmH2O,5례하강정맥-우심방압력차유술전적(26.6±2.7)cmH2O강지술후적(9.4±1.1) cmH2O,차이균유통계학의의(t치분별위21.6화16.1,P ＜0.05).3례환자술후출현경도자격성복통,24 h내완해,무출혈、사망등병발증.6례환자수방16 ～ 90개월,평균(42±27)개월,균무간정맥재협착,5례환자하강정맥균통창,무재협착.결론 하강정맥전정폐새적개입치료안전、유효.
Objective To evaluate the safety and efficacy of interventional treatment of occlusion of the entire inferior vena cava (IVC).Methods The clinical data of 6 patients with entire IVC occlusion were analyzed retrospectively.All patients were diagnosed by color Doppler ultrasound and DSA.Venography was performed under local anesthesia via internal jugular vein and femoral vein approach.The occlusion of IVC and hepatic vein were treated with balloon dilatation and/or stent placement.Follow-up examination with color Doppler ultrasound was taken 1,3,6,12 months after treatment and annually thereafter to assess the patency of IVC and hepatic vein.The pressure gradient of hepatic vein-right atrium and IVC-right atrium before and after interventional treatment were compared with paired t test.Results In 5 cases,both IVC and 1 hepatic vein were recanalized successfully.In 1 case,recanalization of IVC failed,but the right hepatic vein was recanalized successfully.The mean pressure gradient of hepatic vein-right atrium decreased from (23.2 ± 2.0) cmH2O (1 cmH2O =0.098 kPa) before treatment to (8.7 ± 3.2) cmH2O after treatment in 6 cases (t =21.6,P ＜ 0.05).The mean pressure gradient of IVC-right atrium decreased from (26.6 ± 2.7) cmH2O before treatment to (9.4 ± 1.1) cmH2O after treatment (t =16.1,P ＜ 0.05).Abdominal pains occurred in 3 patients after stent implantation which disappeared in 24 hours.No other complications such as bleeding and death occurred.During a mean follow-up of(42 ± 27)months (16 to 90 months),hepatic vein patency was maintained in 6 cases and IVC patency was maintained in 5 cases.Conclusion Interventional treatment of occlusion of the entire IVC is a safe and effective method.