导丝贯穿技术在肝静脉型布加综合征介入治疗中的应用

摘要

目的 探讨导丝贯穿技术在肝静脉型布加综合征(BCS)介入治疗中的应用价值.方法 回顾性分析2011年5月至2014年8月收治的25例肝静脉型BCS患者的临床资料.所有患者均用导丝贯穿法行肝静脉成形术.介入治疗前后测量肝静脉压力,用t检验评价治疗前后肝静脉压力的变化.结果 25例患者均成功用导丝贯穿法行肝静脉成形术.术中无血管破裂出血、心包填塞及肝包膜破裂出血等并发症发生.治疗后肝静脉压力由(48.3±8.0)cmH2O降至(20.9±3.8)cmH2O(t=26.82,P＜0.05),治疗前后差异有统计学意义.术后所有患者临床症状、体征均明显缓解或消失.随访期间有4例患者再次出现BCS相关症状.其中2例再次行球囊扩张治疗成功,1例因肝硬化失代偿改用经颈静脉肝内门体分流(TIPS)治疗,另1例因患强直性脊柱炎第三次症状复发行肝静脉开通治疗失败.结论 采用导丝贯穿技术行肝静脉成形术治疗肝静脉型BCS是一种安全、有效的补充治疗方法,能提高肝静脉型BCS的治疗成功率.%Objective To investigate the value of guide-wire loop in interventional therapy of patients with Budd-Chiari syndrome with hepatic vein obstruction.Methods A retrospective study was conducted on 25 patients with Budd-Chiari syndrome (BCS) with hepatic vein obstruction treated from May 2011 to August 2014.The technique of guide-wire loop was used in these patients.The pressure of the hepatic vein was measured before and after treatment.The difference in the pressure was analyzed by the t test.Results All the patients were treated successfully using guide-wire loop angioplasty.No complications of bleeding,pericardial tamponade and liver capsule hemorrhage were observed.After treatment,the pressure of the hepatic vein reduced from (48.3± 8.0) cmH2O to (20.9 ± 3.8) cmH2O (t =26.82,P ＜ 0.05);The symptoms and physical signs of the patients were relieved or disappeared.BCS-related symptoms reappeared on follow-up in 4 patients,2 were treated by balloon dilation successfully.1 patient was treated with transjugular intrahepatic portosystemic shunt (TIPS) because of decompensated liver cirrhosis.1 patient with ankylosing spondylitis had treatment failure and the symptoms relapsed for the third time.Conclusion The technique of guide-wire loop in interventional therapy of patients with Budd-Chiari syndrome with hepatic vein obstruction is safe and effective,and it can improve the overall success rate of treatment.