布加综合征合并上消化道出血患者的同期介入治疗

摘要

目的 探讨布加综合征(BCS)合并上消化道出血患者同期介入治疗的可行性及临床疗效.方法 回顾性分析郑州大学第一附属医院2015年10月至2018年4月收治的32例布加综合征合并上消化道出血患者的临床资料,同期行曲张静脉栓塞及下腔静脉(IVC)和/或肝静脉(HV)成形术,观察围手术期并发症,并测量手术前后的门静脉压力,术后随访IVC及HV有无再狭窄及消化道出血.结果 32患者均手术成功,其中16例行IVC球囊扩张,17例行HV球囊扩张,均未置入支架;门静脉造影发现17例患者有1支曲张静脉,15例有2支曲张静脉,均成功栓塞.患者经过同期介入治疗,门静脉压力由术前的(35.7±2.9) cmH2O下降至术后的(31.2±2.5) cmH2O(P＜0.05,1 cmH2O=0.098 kPa).治疗前后差异有统计学意义(P＜0.05).其中肝静脉型BCS患者开通HV后,门静脉压力由术前的(35.8±3.0)cmH2O下降至(30.7±2.3) cmH2O;混合型BCS患者开通IVC后,门静脉压力由(35.6±3.0) cmH2O下降至(31.8±2.6)cmH2O,肝静脉型患者门静脉压力下降更明显,差异均有统计学意义(均P＜0.05).患者随访期3～32个月,平均(11.7±7.8)个月.其中7例IVC及5例HV再狭窄,再次行球囊扩张术,随访期内无再发上消化道出血.结论 同期介入治疗BCS合并上消化出血安全可行,中远期效果满意.%Objective To evaluate the feasibility and clinical outcomes of interventional treatment of Budd-Chiari syndrome (BCS) associated with simultaneous upper gastrointestinal hemorrhage.Methods The clinical data of 32 patients of BCS with upper gastrointestinal hemorrhage from October 2015 to April 2008 in First Affiliated Hospital of Zhengzhou University were analyzed retrospectively.Variceal embolization and inferior vena cave (IVC) and/or hepatic veins (HV) angioplasty were performed simultaneously.Perioperative complications were observed.Portal vein pressures were measured through catheterization preand post-operation.Restenosis of IVC and HV,upper gastrointestinal hemorrhage were observed on followup.Results Percutaneous transluminal balloon angioplasty were successfully carried out in all patients:16 patients with IVC and 17 patients with HV stenosis underwent angioplasty without stent placement.Portography indicated one esophageal and gastric varices in 17 patients and two in 15 patients.All the varices were embolized successfully.The portal vein pressure reduced from (35.7±2.9) cmH2O to (31.2±2.5) cmH2O (P ＜ 0.05,1 cmH2O =0.098 kPa).Portal vein pressure reduced from (35.8± 3.0) cmH2O to (30.7±2.3) cmH2O in HV type BCS post-operation,and reduce from (35.6±3.0) cmH2O to (31.8±2.6) cmH2O in HV and IVC involved type,which indicated that portal vein pressure decreased more obviously after HV recanalization.On follow-up for 3 to 32 months (mean 11.7 ±7.8 months),7 patients with IVC and 5 patients with HV stenosis developed restenosis.Transluminal balloon angioplasty was performed.No upper gastrointestinal hemorrhage occurred during the follow-up period.Conclusion One-stage interventional treatment of BCS with upper gastrointestinal hemorrhage was safe and effective,and had satisfactory mediumlong term outcomes.