副肝静脉支架置入治疗布加综合征的疗效

摘要

目的 探讨副肝静脉(AHV)支架置入治疗布加综合征(BCS)的安全性和疗效.方法 回顾性分析20例BCS伴AHV开口狭窄或闭塞患者的临床资料.全部患者均施行了AHV球囊扩张及支架置入术,其中13例经右颈静脉途径、5例经右股静脉途径、2例经皮经肝联合经右股静脉途径行AHV开通术.术后采用彩色多普勒超声随访,观察AHV支架通畅情况,采用Kaplan-Meier曲线评估首次及再次通畅率.结果 20例患者均成功开通AHV,支架置入术后造影示AHV血流均通畅.AHV-下腔静脉压差由术前平均(19.2±4.8)cmH2O(1 cmH2O=0.098 kPa)降至术后平均(4.5±1.9) cmH2O,差异有统计学意义(t=7.119,P＜0.01).术中球囊扩张致AHV破裂出血1例,行覆膜支架置入后治愈.20例患者随访1 ～ 80个月,平均(32.1 ±27.4)个月.AHV支架再狭窄5例,经再次球囊扩张治疗成功.术后1、3、5年首次通畅率分别为100％、85.1％、74.5％;再次通畅率分别为100％,90.9％,90.9％.1例于术后3年死于肝衰竭.结论 AHV支架置入治疗BCS安全、有效,可获得较好的中远期疗效.%Objective To study the safety and efficacy of accessory hepatic vein (AHV) stenting to treat primary Budd-Chiari syndrome (BCS).Methods The clinical data of 20 BCS patients with AHV ostial stenosis or occlusion were retrospectively analyzed.These 20 patients underwent balloon dilation and AHV stenting.Thirteen patients underwent AHV stenting via the right jugular vein approach,5 patients via the right femoral vein approach,and 2 patients via the percutaneous transhepatic combined with the right femoral vein approach.On follow-up,patency of the AHV stent was evaluated by color Doppler ultrasound.The cumulative primary and secondary patency rates were assessed with the Kaplan-Meier curves.Results AHV stenting was successful in 20 patients.Angiography showed that the AHV was patent after stenting.The mean pressure gradient between the AHV and the inferior vena cava reduced from (19.2 ± 4.8) cmH2O (1 cmH2O =0.098 kPa) before treatment to (4.5 ± 1.9) cmH2O after treatment (t =7.119,P ＜ 0.01).During the procedure,rupture of the AHV caused by balloon dilation occurred in one patient.This was treated successfully by a covered stent placement.On follow-up from 1 to 80 months [(32.1 ±27.4) months]after treatment for the 20 patients,re-stenosis of the AHV were found in 5 patients.They were treated successfully with re-dilation.The cumulative 1-,3-,and 5-year primary patency rates were 100％,85.1％ and 74.5％,respectively.The cumulative 1-,3-,and 5-year secondary patency rates were 100％,90.9％ and 90.9％,respectively.One patient died of hepatic failure 3 years after the treatment.Conclusion AHV stenting was a safe and efficacious treatment for BCS and it provided good mid-and long-term results.