肝静脉阻塞型布加综合征介入治疗的临床疗效
간정맥조새형포가종합정개입치료적림상료효
Clinical efficacy of interventional treatment for Budd-Chiari syndrome in patients with hepatic vein occlusion
  • 万方数据
    中华消化外科杂志 중화소화외과잡지
    CHINESE JOURNAL OF DIGESTIVE SURGERY
    2014年 8期 637-641 ,共5页

    成德雷%徐浩%华荣%吕维富%祖茂衡%张庆桥%徐新建%杜洪涛

    성덕뢰%서호%화영%려유부%조무형%장경교%서신건%두홍도

    布加综合征%肝静脉%介入治疗%球囊扩张术%支架置入术 佈加綜閤徵%肝靜脈%介入治療%毬囊擴張術%支架置入術
    포가종합정%간정맥%개입치료%구낭확장술%지가치입술
    Budd-Chiari syndrome%Hepatic vein%Interventional therapy%Balloon dilatation%Stent implantation
    目的 探讨肝静脉阻塞型布加综合征(BCS)介入治疗的临床疗效.方法 回顾性分析2010年12月至2012年12月安徽省立医院和徐州医学院附属医院收治的69例肝静脉阻塞型BCS行介入治疗患者的临床资料,采用经颈静脉、股静脉或经皮经肝联合下腔静脉途径开通肝静脉,行球囊扩张术或支架置入术,若肝静脉无法介入则行经颈静脉肝内门体分流术,观察肝静脉压力及患者临床症状的变化,评估治疗后无症状生存率.采用电话和门诊随访,随访时间截至2013年7月.计量资料用(x-)±s表示,采用t检验.等级资料采用Wilcoxon W秩和检验.采用Kaplan-Meier法绘制生存曲线,生存率比较采用Log-rank检验.结果 66例患者成功行介入治疗,经颈静脉43例,股静脉14例,经皮经肝穿刺9例;单纯球囊扩张术41例,球囊扩张术+溶栓治疗14例,球囊扩张术+支架置入术6例,球囊扩张术+溶栓术+支架置入术5例.61例患者术后症状完全缓解,其他5例症状部分缓解.BCS患者介入治疗前后肝静脉压力分别为(47±9)cmH2O(1 cmH2O =0.098 kPa)和(23±7)cmH2O,两者比较,差异有统计学意义(t=9.73,P＜0.05).入院时腹腔积液有66例,治疗后减少至13例,两者比较,差异有统计学意义(Z=10.38,P＜0.05).66例成功行介入治疗的患者均获随访,中位随访时间为15个月(6～ 24个月).随访期间10例患者再次出现BCS相关症状,7例再次介入治疗成功,其余3例治疗失败.BCS患者首次介入治疗术后6、12、24个月无症状生存率分别为97.0％、92.2％、76.4％;再次介入治疗后无症状生存率分别为98.4％、98.4％、92.3％.单纯行球囊扩张术患者首次介入后无症状生存率为90.2％;球囊扩张术+溶栓术患者为71.4％;球囊扩张术+支架置入术患者为83.3％;球囊扩张术+溶栓术+支架置入术患者为80.0％.BCS患者行不同介入治疗后无症状生存率比较,差异无统计学意义(x2=3.08,P ＞0.05).结论 介入治疗肝静脉阻塞型BCS成功率高,复发率低,中短期无症状生存率高.
    목적 탐토간정맥조새형포가종합정(BCS)개입치료적림상료효.방법 회고성분석2010년12월지2012년12월안휘성립의원화서주의학원부속의원수치적69례간정맥조새형BCS행개입치료환자적림상자료,채용경경정맥、고정맥혹경피경간연합하강정맥도경개통간정맥,행구낭확장술혹지가치입술,약간정맥무법개입칙행경경정맥간내문체분류술,관찰간정맥압력급환자림상증상적변화,평고치료후무증상생존솔.채용전화화문진수방,수방시간절지2013년7월.계량자료용(x-)±s표시,채용t검험.등급자료채용Wilcoxon W질화검험.채용Kaplan-Meier법회제생존곡선,생존솔비교채용Log-rank검험.결과 66례환자성공행개입치료,경경정맥43례,고정맥14례,경피경간천자9례;단순구낭확장술41례,구낭확장술+용전치료14례,구낭확장술+지가치입술6례,구낭확장술+용전술+지가치입술5례.61례환자술후증상완전완해,기타5례증상부분완해.BCS환자개입치료전후간정맥압력분별위(47±9)cmH2O(1 cmH2O =0.098 kPa)화(23±7)cmH2O,량자비교,차이유통계학의의(t=9.73,P＜0.05).입원시복강적액유66례,치료후감소지13례,량자비교,차이유통계학의의(Z=10.38,P＜0.05).66례성공행개입치료적환자균획수방,중위수방시간위15개월(6～ 24개월).수방기간10례환자재차출현BCS상관증상,7례재차개입치료성공,기여3례치료실패.BCS환자수차개입치료술후6、12、24개월무증상생존솔분별위97.0％、92.2％、76.4％;재차개입치료후무증상생존솔분별위98.4％、98.4％、92.3％.단순행구낭확장술환자수차개입후무증상생존솔위90.2％;구낭확장술+용전술환자위71.4％;구낭확장술+지가치입술환자위83.3％;구낭확장술+용전술+지가치입술환자위80.0％.BCS환자행불동개입치료후무증상생존솔비교,차이무통계학의의(x2=3.08,P ＞0.05).결론 개입치료간정맥조새형BCS성공솔고,복발솔저,중단기무증상생존솔고.
    Objective To investigate the clinical efficacy of interventional treatment for Budd-Chiari syndrome (BCS) in patients with hepatic vein occlusion.Methods The clinical data of 69 patients with BCS who received interventional treatment at the Anhui Provincial Hospital and Affiliated Hospital of Xuzhou Medical College from December 2010 to December 2012 were retrospectively analyzed.The hepatic vein was recanalized by balloon dilatation or stent implantation via jugular vein,femoral vein or percutalleous transhepatic approach or via inferior vena cava.Transjugular intraheptic portosystemic shut was applied when recanalization of hepatic vein failed.The changes of hepatic vein pressure and the clinical symptoms were observed,and the post-treatment disease free survival rate was evaluated.Patients were followed up by phone call and out-patient examination till July 2013.The measurement data were presented as (x-) ±s,and were analyzed using the t test.Ranked data were analyzed using the Wilcoxon W test.The survival curve was drawn using the Kaplan-Meier method,and the survival rate was compared using the Log-rank test.Results Interventional treatment was successfully performed on 66 patients.Transjugular intervention was applied on 43 patients,transfemoral intervention on 14 patients and percutaneous transhepatic intervention on 9 patients.Forty-one patients received balloon dilatation,14 received balloon dilatation + thrombolysis,6 received balloon dilatation + stent implantation,and 5 received balloon dilatation + thrombolysis + stent implantation.The symptoms of 61 patients were completely relieved after treatment,and the symptoms of 5 patients were partially relieved.The hepatic vein pressures before and after treatment were (47 ± 9) cmH2O (1 cmH2O =0.098 kPa) and (23 ± 7) cmH2O,with significant difference between the 2 groups (t =9.73,P ＜ 0.05).The number of patients with peritoneal effusion decreased from 66 before operation to 13 after operation (Z =10.38,P ＜ 0.05).Sixty-six patients were followed up with the median time of follow-up of 15 months (range,6-24 months).BCS-related symptoms were detected during the follow-up in 10 patients,and 7 patients were cured by re-interventional treatment,and reparative treatment was failed in the other 3 patients.The disease-free survival rates at month 6,12 and 24 after initial interventional therapy were 97.0％,92.2％ and 76.4％,and the disease-free survival rates at month 6,12 and 24 after reparative treatment were 98.4％,98.4％ and 92.3％.The disease-free survival rates of patients who received balloon dilation,balloon dilation + thrombolysis,balloon dilation + stent implantation,balloon dilation + thrombolysis + stent implantation were 90.2％,71.4％,83.3％ and 80.0％,respectively.There was no significant difference in the disease-free survival rates among different treatment methods (x2=3.08,P ＞ 0.05).Conclusion Interventional treatment of BCS has the advantages of high success rate,low recurrence rate and high middle-short term disease-free survival rate.
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