CAJ | 학술논문

目的评价血管腔内治疗布加综合征(BCS)合并下腔静脉血栓的中长期疗效.方法回顾性分析145例BCS合并下腔静脉血栓患者的临床资料.145例中,男89例,女56例,年龄15～81岁,平均(48.6±12.3)岁.全部患者均经彩色多普勒超声、下腔静脉造影和下腔静脉血栓抽吸检查确诊.其中新鲜血栓71例,混合血栓36例,陈旧血栓38例.采用血栓抽吸、经导管尿激酶溶栓、球囊扩张和(或)支架置入治疗.术后采用彩色多普勒超声随访,使用Kaplan-Meier曲线计算首次及再次通畅率,并对再闭塞的因素进行Cox回归分析.结果血管腔内治疗成功率98.6％(143/145),并发症发生率4.8％ (7/145).143例患者中125例获得随访,随访时间3～132个月,平均(55.9±36.7)个月.随访期间死亡3例,再闭塞16例,其中12例经再次血管腔内治疗成功.1、5、10年首次通畅率分别为96.3％、84％和64.6％;再次通畅率分别为99％、96.1％和91.3％.多因素分析显示,下腔静脉节段闭塞和抗凝治疗时间≤6个月为预测再闭塞的独立危险因素.结论血管腔内治疗BCS合并下腔静脉血栓可获得较好的中长期疗效.
목적 평개혈관강내치료포가종합정(BCS)합병하강정맥혈전적중장기료효.방법 회고성분석145례BCS합병하강정맥혈전환자적림상자료.145례중,남89례,녀56례,년령15～81세,평균(48.6±12.3)세.전부환자균경채색다보륵초성、하강정맥조영화하강정맥혈전추흡검사학진.기중신선혈전71례,혼합혈전36례,진구혈전38례.채용혈전추흡、경도관뇨격매용전、구낭확장화(혹)지가치입치료.술후채용채색다보륵초성수방,사용Kaplan-Meier곡선계산수차급재차통창솔,병대재폐새적인소진행Cox회귀분석.결과 혈관강내치료성공솔98.6％(143/145),병발증발생솔4.8％ (7/145).143례환자중125례획득수방,수방시간3～132개월,평균(55.9±36.7)개월.수방기간사망3례,재폐새16례,기중12례경재차혈관강내치료성공.1、5、10년수차통창솔분별위96.3％、84％화64.6％;재차통창솔분별위99％、96.1％화91.3％.다인소분석현시,하강정맥절단폐새화항응치료시간≤6개월위예측재폐새적독립위험인소.결론 혈관강내치료BCS합병하강정맥혈전가획득교호적중장기료효.
Objective To evaluate the mid-and long-term efficacy of endovascular treatment for Budd-Chiari syndrome (BCS) complicated by inferior vena cava (IVC) thrombosis.Methods The clinical data of 145 patients with BCS complicated by IVC thrombosis (89 males and 56 females) age between 15 to 81 years with a mean age of (48.6±12.3) years were analyzed retrospectively.All 145 patients were diagnosed using color Doppler ultrasound,IVC angiography and aspiration of the IVC thrombus.Among them,there were 71 cases of fresh thrombus,36 cases of mixed thrombus and 38 cases of old thrombus.All patients underwent endovascular treatments including thrombus aspiration,transcatheter thrombolysis,percutaneous transluminal angioplasty and/or stent implantation.On follow-up,re-thrombosis and patency of the IVC were evaluated by color Doppler ultrasound.The cumulative primary and secondary patency ratio were assessed with Kaplan-Meier curves.Independent predictors of patency were calculated with the Cox regression model.Results Endovascular treatment was technically successful in 143 of the 145 patients (98.6 ％).Seven of the 145 patients (4.8 ％) suffered from complications.The average duration of follow-up in 143 patients was 3 to 132 (55.9±36.7) months.18 patients were lost to follow-up.Among the remaining 125 patients,3 patients died and IVC reocclusion occurred in 16 patients.Secondary endovascular treatment was performed successfully in 12 patients.The cumulative 1-,5-,and 10-year primary patency rates were 96.3％,84％and 64.6％ respectively.The cumulative 1-,5-,and 10 year secondary patency rates were 99％,96.1 ％ and 91.3 ％ respectively.Segmental occlusion of the IVC and duration of anticoagulant therapy of less than six months were independent risk factors of reocclusion.Conclusion Endovascular treatment for BCS complicated by IVC thrombosis achieved excellent mid-and long-term patency rates.