中华肝胆外科杂志
中華肝膽外科雜誌
중화간담외과잡지
CHINESE JOURNAL OF HEPATOBILIARY SURGERY
2014年
5期
346-350
,共5页
傅宇飞%张科%魏宁%徐浩
傅宇飛%張科%魏寧%徐浩
부우비%장과%위저%서호
布加综合征%介入治疗%副肝静脉
佈加綜閤徵%介入治療%副肝靜脈
포가종합정%개입치료%부간정맥
Budd-Chiari syndrome%Interventional treatment%Accessory hepatic vein
目的 探讨副肝静脉在布加综合征(BCS)患者介入治疗中的意义.方法 将2011年3月至2013年6月我科35例存在副肝静脉的BCS患者根据其是否梗阻分为2组.其中副肝静脉通畅组21例,病变特点为下腔静脉伴三支肝静脉梗阻,副肝静脉粗大、通畅;副肝静脉梗阻组14例,病变特点为副肝静脉及三支肝静脉梗阻,其中下腔静脉通畅13例,下腔静脉梗阻1例.在治疗过程中,副肝静脉通畅组患者行下腔静脉球囊扩张术(或支架置入术);副肝静脉梗阻组患者行副肝静脉球囊扩张术(或支架置入术),1例合并下腔静脉梗阻的患者先行下腔静脉球囊扩张术.结果 所有患者均一次性治疗成功,未出现治疗相关并发症.副肝静脉通畅组21例副肝静脉压力由术前的(28.81±6.23)cmH2O(1 cmH2O =0.098 kPa)降至治疗后的平均(18.62±5.06) cmH2O (P ＜0.01);血清总胆红素由治疗前的(23.24±6.41) μmol/L降至治疗后的(19.52 ±4.31) μmol/L(P ＜0.01);血清白蛋白治疗前(33.76±3.74)g/L,治疗后(34.05±3.62)g/L(P =0.485).副肝静脉梗阻组副肝静脉压力由术前的(36.29±11.65) cmH2O降至治疗后的(22.07 ±7.67)cmH2O(P ＜0.01);血清总胆红素由治疗前的(31.24±9.54) μmo]/L降至治疗后的(20.93±7.26) μmol,/L(P＜0.01);血清白蛋白治疗前(32.14±4.55) g/L,治疗后(32.11±4.47)g/L(P =0.861).经随访,副肝静脉通畅组患者无症状复发.副肝静脉梗阻组中1例于治疗后5个月症状复发,再次给予副肝静脉球囊扩张术.结论 对于下腔静脉伴三支肝静脉狭窄或闭塞的患者,若副肝静脉代偿性增粗、通畅,术中仅需处理下腔静脉即可.对于副肝静脉伴三支肝静脉狭窄或闭塞的患者,若副肝静脉代偿性增粗、扩张,开通副肝静脉是安全、有效的治疗途径.
目的 探討副肝靜脈在佈加綜閤徵(BCS)患者介入治療中的意義.方法 將2011年3月至2013年6月我科35例存在副肝靜脈的BCS患者根據其是否梗阻分為2組.其中副肝靜脈通暢組21例,病變特點為下腔靜脈伴三支肝靜脈梗阻,副肝靜脈粗大、通暢;副肝靜脈梗阻組14例,病變特點為副肝靜脈及三支肝靜脈梗阻,其中下腔靜脈通暢13例,下腔靜脈梗阻1例.在治療過程中,副肝靜脈通暢組患者行下腔靜脈毬囊擴張術(或支架置入術);副肝靜脈梗阻組患者行副肝靜脈毬囊擴張術(或支架置入術),1例閤併下腔靜脈梗阻的患者先行下腔靜脈毬囊擴張術.結果 所有患者均一次性治療成功,未齣現治療相關併髮癥.副肝靜脈通暢組21例副肝靜脈壓力由術前的(28.81±6.23)cmH2O(1 cmH2O =0.098 kPa)降至治療後的平均(18.62±5.06) cmH2O (P ＜0.01);血清總膽紅素由治療前的(23.24±6.41) μmol/L降至治療後的(19.52 ±4.31) μmol/L(P ＜0.01);血清白蛋白治療前(33.76±3.74)g/L,治療後(34.05±3.62)g/L(P =0.485).副肝靜脈梗阻組副肝靜脈壓力由術前的(36.29±11.65) cmH2O降至治療後的(22.07 ±7.67)cmH2O(P ＜0.01);血清總膽紅素由治療前的(31.24±9.54) μmo]/L降至治療後的(20.93±7.26) μmol,/L(P＜0.01);血清白蛋白治療前(32.14±4.55) g/L,治療後(32.11±4.47)g/L(P =0.861).經隨訪,副肝靜脈通暢組患者無癥狀複髮.副肝靜脈梗阻組中1例于治療後5箇月癥狀複髮,再次給予副肝靜脈毬囊擴張術.結論 對于下腔靜脈伴三支肝靜脈狹窄或閉塞的患者,若副肝靜脈代償性增粗、通暢,術中僅需處理下腔靜脈即可.對于副肝靜脈伴三支肝靜脈狹窄或閉塞的患者,若副肝靜脈代償性增粗、擴張,開通副肝靜脈是安全、有效的治療途徑.
목적 탐토부간정맥재포가종합정(BCS)환자개입치료중적의의.방법 장2011년3월지2013년6월아과35례존재부간정맥적BCS환자근거기시부경조분위2조.기중부간정맥통창조21례,병변특점위하강정맥반삼지간정맥경조,부간정맥조대、통창;부간정맥경조조14례,병변특점위부간정맥급삼지간정맥경조,기중하강정맥통창13례,하강정맥경조1례.재치료과정중,부간정맥통창조환자행하강정맥구낭확장술(혹지가치입술);부간정맥경조조환자행부간정맥구낭확장술(혹지가치입술),1례합병하강정맥경조적환자선행하강정맥구낭확장술.결과 소유환자균일차성치료성공,미출현치료상관병발증.부간정맥통창조21례부간정맥압력유술전적(28.81±6.23)cmH2O(1 cmH2O =0.098 kPa)강지치료후적평균(18.62±5.06) cmH2O (P ＜0.01);혈청총담홍소유치료전적(23.24±6.41) μmol/L강지치료후적(19.52 ±4.31) μmol/L(P ＜0.01);혈청백단백치료전(33.76±3.74)g/L,치료후(34.05±3.62)g/L(P =0.485).부간정맥경조조부간정맥압력유술전적(36.29±11.65) cmH2O강지치료후적(22.07 ±7.67)cmH2O(P ＜0.01);혈청총담홍소유치료전적(31.24±9.54) μmo]/L강지치료후적(20.93±7.26) μmol,/L(P＜0.01);혈청백단백치료전(32.14±4.55) g/L,치료후(32.11±4.47)g/L(P =0.861).경수방,부간정맥통창조환자무증상복발.부간정맥경조조중1례우치료후5개월증상복발,재차급여부간정맥구낭확장술.결론 대우하강정맥반삼지간정맥협착혹폐새적환자,약부간정맥대상성증조、통창,술중부수처리하강정맥즉가.대우부간정맥반삼지간정맥협착혹폐새적환자,약부간정맥대상성증조、확장,개통부간정맥시안전、유효적치료도경.
Objective To investigate the significance of an accessory hepatic vein (AHV) in the interventional treatment of Budd-Chiari syndrome (BCS).Methods From Mar.2011 to Jun.2013,35 patients with BCS who also had an AHV were included into this study.The patients were divided into two groups according to whether the AHV was obstructive:21 patients had obstruction to the inferior vena cava (IVC) and to the 3 hepatic veins (HV),but the AHV was open; 14 patients had obstruction to the AHV and the 3 HVs.In 13 of these patients the IVC was open,but 1 patient had obstruction to the IVC.During treatment,the patients in the AHV open group underwent balloon dilation or stent insertion of IVC ; patients in the AHV obstruction group underwent balloon dilation or stent insertion of AHV.The patient with obstruction to the IVC underwent balloon dilation of IVC first.Results All patients were successfully treated without any procedure-related complications.In the AHV open group,the average pressure of the AHV decreased from (28.81 ± 6.23) cmH2 O (1 cmH2O =0.098 kPa) before treatment to (18.62 ± 5.06) cmH2O after treatment (P ＜ 0.01) ; the average serum TBIL decreased from (23.24 ± 6.41) μmol/L before treatment to (19.52 ± 4.31) μmol/L after treatment (P ＜ 0.01) ; the average serum albumin changed from (33.76 ± 3.74) g/L before treatment to (34.05 ± 3.62) g/L after treatment (P =0.485).In the AHV obstruction group,the average pressure of the AHV decreased from (36.29 ± 11.65) cmH2O before treatment to (22.07 ± 7.67) cmH2O after treatment (P ＜ 0.01) ; the average serum TBIL decreased from (31.24 ± 9.54) μmol/L before treatment to (20.93 ±7.26) μmol/L after treatment (P ＜0.01) ; the average serum albumin changed from (32.14 ± 4.55) g/L before treatment to (32.11 ± 4.47) g/L after treatment (P =0.861).During follow-up,no patients experienced recurrence of symptoms in the AHV open group; one patient experienced recurrence of symptoms 5 months after treatment in the AHV obstruction group.This patient received a second balloon dilation of the AHV.Conclusions For patients with BCS with IVC and the 3 HVs obstruction,if the AHV was open,we could only treat the IVC.For patients with BCS with AHV and the 3 HVs obstruction,AHV dilation followed by recanalization of AHV was also effective.
