CAJ | 학술논문

目的探讨混合型布加综合征(Budd-Chiari syndrome,BCS)的介入治疗方法.方法分析2011年6月至2013年3月收治的162例混合型BCS血管病变特征和治疗方法,观察开通后肝静脉(hepatic veins,HV)和下腔静脉(inferior vena cava,IVC)压力以及患者症状的变化,评估治疗后无症状生存率.结果本组162例中,53例患者合并3支主HV阻塞且无2支以上粗大副肝静脉代偿,行HV和IVC联合开通治疗,其中51例治疗成功;其余109例患者仅行IVC开通治疗,其中106例治疗成功;总体技术成功率为96.9％ (157/162).本组患者开通治疗前后HV和IVC压力分别为:[(40±9) cmH2O和(28±7)cmH2O]比[(22±7) cmH2O和(19±6) cmH2O],差异均有统计学意义(Z=7.42和8.75,P＜0.001).157例治疗成功患者均获得6个月以上的随访,随访时间6～24个月,中位时间为15个月.出院后146例症状完全缓解,其余11例症状改善,随访截止时,首次开通治疗和修正治疗后的无症状生存率分别为:82.4％和94.2％.结论根据HV病变特征选择混合型BCS患者介入治疗方法,疗效好,复发率低,短中期无症状生存率高.
목적 탐토혼합형포가종합정(Budd-Chiari syndrome,BCS)적개입치료방법.방법 분석2011년6월지2013년3월수치적162례혼합형BCS혈관병변특정화치료방법,관찰개통후간정맥(hepatic veins,HV)화하강정맥(inferior vena cava,IVC)압력이급환자증상적변화,평고치료후무증상생존솔.결과 본조162례중,53례환자합병3지주HV조새차무2지이상조대부간정맥대상,행HV화IVC연합개통치료,기중51례치료성공;기여109례환자부행IVC개통치료,기중106례치료성공;총체기술성공솔위96.9％ (157/162).본조환자개통치료전후HV화IVC압력분별위:[(40±9) cmH2O화(28±7)cmH2O]비[(22±7) cmH2O화(19±6) cmH2O],차이균유통계학의의(Z=7.42화8.75,P＜0.001).157례치료성공환자균획득6개월이상적수방,수방시간6～24개월,중위시간위15개월.출원후146례증상완전완해,기여11례증상개선,수방절지시,수차개통치료화수정치료후적무증상생존솔분별위:82.4％화94.2％.결론 근거HV병변특정선택혼합형BCS환자개입치료방법,료효호,복발솔저,단중기무증상생존솔고.
Objective To evaluate interventional treatment and efficacy for Budd-Chiari syndrome (BCS) caused by combined hepatic veins (HV) and inferior vena cava (IVC) occlusion (MIX type).Methods An analysis was made on the characteristics of vascular lesion features and interventional treatment of 162 BCS patients in MIX type from June 2011 to March 2013,to observe the pressure changes in HV and IVC and symptoms.Result Among 162 mixed type BCS patients,there were 53 patients identified with 3 main HV occlusion and less than 2 large accessory HV compensation undergoing both HV and IVC interventional openings,procedures were successful in 51 cases.Other 109 patients received IVC interventional treatment,106 cases were successful; The overall technical success rate was 96.9％ (157/162).The pressure of HV and IVC before and after treatment was [(40 ± 9) cmHl2O and (28 ± 7) cmH2O] vs [(22 ±7) cmH2O and (19 ±6) cmH2O],the difference was statistically significant (Z =7.42 and 8.75,P ＜ 0.001).The median follow-up time of the 157 cases with treatment success was 15 months (range,6-24 months).In this group,146 patients were cured,and the rest 11 patients were improved.The symptomfree rate after first intervention and reparative therapy was 82.4％ and 94.2％.Conclusions Interventional treatment strategy according to the HV lesion characteristics has satisfactory efficacy and low recurrence rate in middle term for mixed type BCS patients.