复杂布—卡综合征的介入治疗(摘要)
作者：郭玉军 武长军 刘庆贺
单位：河南省新乡市，新乡铁路医院 介入治疗中心(453000)
关键词：
目的 目的：应用介入方法治疗复杂的布—卡氏综合征。
方法：经皮穿刺对下腔静脉或肝静脉完全闭塞者实施开通术及球囊成形术。例1，下腔静脉完全闭塞，长约9 cm,侧枝循环良好，肝静脉扩张，三支汇合后开口闭塞；例2、例3均为下腔静脉膜性闭塞。
结果：例1经皮经肝穿刺肝右静脉，导丝破膜后送达右心房，但扩张鞘无法送入，遂穿刺颈内静脉，将导丝由右心房拉出，建立体外—肝实质—肝静脉—下腔静脉—右心房—颈内静脉—体外导丝轨道，用Rups-100器具及球囊导管扩张肝静脉，随访8个月无再狭窄。例2，颈内静脉穿刺造影见上腔静脉闭塞，穿刺股静脉后在床边B型超声心动图引导下以心房间隔穿刺针破膜，球囊成形，随访4个月无再狭窄。例3，穿刺颈内静脉及股静脉，对端造影后，硬导丝破膜，球囊成形，随诊6周无复发。
, http://www.100md.com
结论：介入治疗已成为布—卡氏综合征的首选治疗方法。完全闭塞者技术难度大。我们通过3例完全闭塞者的介入治疗，认为：①肝静脉成形较下腔静脉成形更为重要，下腔静脉闭塞者并非均有症状。②肝静脉开通时，经皮经肝穿刺可能是最易成功的途径。③下腔静脉膜性闭塞无法进行对端造影时，床边B型超声心动图对开通术有指导意义。④复杂布—卡氏综合征的介入治疗依赖于全面的导管技术，充分的器械准备及合理的治疗方案。
Interventional Therapy in Treating Complex Budd-Chiari Syndrome (Abstract)
Intervention Treatment Center, Xinxiang Railway Hospital, Xinxiang (453003), He′nan
Guo Yujun, Wu Changjun, Liu Qinghe.
, 百拇医药
Objective: To treat complex Budd-Chiari syndrome with interventional therapy.
Methods: Complete obstruction was removed and saccule plastic operation was performed in the inferior vena cava or hepatic veins by transcutaneous puncture. Case 1 had complete obstruction in inferior vena cava (9 cm long). Collateral branches maintained good circulation and hepatic veins dilated. The opening was blocked after 3 branches joined. Case 2 and case 3 had obstruction in the inferior vena cava.
, 百拇医药
Results: In case 1, transcutaneous intrahepatic puncture was done in the right hepatic vein and guide wire was forced into the right atrium after the rupture of membranes. The wire could not be sent into the dilated sheath, so internal jugular vein was puncturerd, the guide wire pulled out from the right artrium. An external guide wire orbit was established from extracorpus liver parenchyma-hepatic vein -inferior vena cava -right artrium -internal jugular vein -extracorpus. Stenosis was not detected in 8-month follow-up after the hepatic vein was dilated with Rups-100 instrument and saccule duct. In case 2, obstruction was found by intravenous angiography in the superior vena cava. After abdominal vein puncture, the membranes were ruptured in bed-side by interauricular puncture needle guided by B-ultrasonography and saccule plastic operation was also done. No obstruction was found in 4-month follow-up. In case 3, after the puncture of internal jugular vein and abdominal vein and end-to-end angiography, the rupture of membranes was done by a hard duct and saccule plastic operation was performed. There was no relapse in 6 month follow up.
, 百拇医药
Conclusion: Interventional therapy is the first choice for Budd-Chiari syndrome, though more difficult for complete obstruction. The results indicated that: ① plastic operation in hepatic vein is more important than that in inferior vena cava and all the patients with vena cava obstruction are unlikely to have symptoms; ② transcutaneous intrahepatic puncture is likely to be the most successful means when hepatic veins are opened; ③ when end-to-end angiography can not be done for the inferior vena cava obstruction, the bed-side B ultrasonography is useful in guiding the reopening of obstruction; ④ interventional therapy in treating complex Budd Chiari syndrome depends upon perfect duct techniques, adequate preparations of instruments and sensible thrapeutic scheme., http://www.100md.com
单位：河南省新乡市，新乡铁路医院 介入治疗中心(453000)
关键词：
目的 目的：应用介入方法治疗复杂的布—卡氏综合征。
方法：经皮穿刺对下腔静脉或肝静脉完全闭塞者实施开通术及球囊成形术。例1，下腔静脉完全闭塞，长约9 cm,侧枝循环良好，肝静脉扩张，三支汇合后开口闭塞；例2、例3均为下腔静脉膜性闭塞。
结果：例1经皮经肝穿刺肝右静脉，导丝破膜后送达右心房，但扩张鞘无法送入，遂穿刺颈内静脉，将导丝由右心房拉出，建立体外—肝实质—肝静脉—下腔静脉—右心房—颈内静脉—体外导丝轨道，用Rups-100器具及球囊导管扩张肝静脉，随访8个月无再狭窄。例2，颈内静脉穿刺造影见上腔静脉闭塞，穿刺股静脉后在床边B型超声心动图引导下以心房间隔穿刺针破膜，球囊成形，随访4个月无再狭窄。例3，穿刺颈内静脉及股静脉，对端造影后，硬导丝破膜，球囊成形，随诊6周无复发。
, http://www.100md.com
结论：介入治疗已成为布—卡氏综合征的首选治疗方法。完全闭塞者技术难度大。我们通过3例完全闭塞者的介入治疗，认为：①肝静脉成形较下腔静脉成形更为重要，下腔静脉闭塞者并非均有症状。②肝静脉开通时，经皮经肝穿刺可能是最易成功的途径。③下腔静脉膜性闭塞无法进行对端造影时，床边B型超声心动图对开通术有指导意义。④复杂布—卡氏综合征的介入治疗依赖于全面的导管技术，充分的器械准备及合理的治疗方案。
Interventional Therapy in Treating Complex Budd-Chiari Syndrome (Abstract)
Intervention Treatment Center, Xinxiang Railway Hospital, Xinxiang (453003), He′nan
Guo Yujun, Wu Changjun, Liu Qinghe.
, 百拇医药
Objective: To treat complex Budd-Chiari syndrome with interventional therapy.
Methods: Complete obstruction was removed and saccule plastic operation was performed in the inferior vena cava or hepatic veins by transcutaneous puncture. Case 1 had complete obstruction in inferior vena cava (9 cm long). Collateral branches maintained good circulation and hepatic veins dilated. The opening was blocked after 3 branches joined. Case 2 and case 3 had obstruction in the inferior vena cava.
, 百拇医药
Results: In case 1, transcutaneous intrahepatic puncture was done in the right hepatic vein and guide wire was forced into the right atrium after the rupture of membranes. The wire could not be sent into the dilated sheath, so internal jugular vein was puncturerd, the guide wire pulled out from the right artrium. An external guide wire orbit was established from extracorpus liver parenchyma-hepatic vein -inferior vena cava -right artrium -internal jugular vein -extracorpus. Stenosis was not detected in 8-month follow-up after the hepatic vein was dilated with Rups-100 instrument and saccule duct. In case 2, obstruction was found by intravenous angiography in the superior vena cava. After abdominal vein puncture, the membranes were ruptured in bed-side by interauricular puncture needle guided by B-ultrasonography and saccule plastic operation was also done. No obstruction was found in 4-month follow-up. In case 3, after the puncture of internal jugular vein and abdominal vein and end-to-end angiography, the rupture of membranes was done by a hard duct and saccule plastic operation was performed. There was no relapse in 6 month follow up.
, 百拇医药
Conclusion: Interventional therapy is the first choice for Budd-Chiari syndrome, though more difficult for complete obstruction. The results indicated that: ① plastic operation in hepatic vein is more important than that in inferior vena cava and all the patients with vena cava obstruction are unlikely to have symptoms; ② transcutaneous intrahepatic puncture is likely to be the most successful means when hepatic veins are opened; ③ when end-to-end angiography can not be done for the inferior vena cava obstruction, the bed-side B ultrasonography is useful in guiding the reopening of obstruction; ④ interventional therapy in treating complex Budd Chiari syndrome depends upon perfect duct techniques, adequate preparations of instruments and sensible thrapeutic scheme., http://www.100md.com