【摘要】 目的　探讨肝静脉型Budd Chiari综合征介入治疗方法选择和疗效的评估。方法　 36例肝静脉型Budd Chiari综合征患者 ,肝功能Child分级 :A级 9例 ,B级 2 1例 ,C级 6例。术前常规行腹部彩超检查及胃镜检查 ,31例患者行CT扫描及肝脏血管重建。介入治疗方法 :经颈静脉 (股静脉 ) 下腔静脉途径行肝静脉 (或副肝静脉 )开通 ;经皮经肝穿刺肝静脉途径行肝静脉开通 ;经颈静脉行肝内门 腔静脉支架分流术 (改良式TIPS)。术中常规行肝静脉、门静脉造影和测压和下腔静脉造影 ,术后给予护肝、抗感染及长期口服阿司匹林和双嘧达莫抗凝治疗。结果　 19例患者行肝静脉球囊扩张术 ,其中 14例患者扩张后置入网状内支架共 18枚。 5例患者经股静脉穿刺行副肝静脉球囊扩张术 ,其中 4例患者扩张后共置入网状内支架 4枚。 2 4例患者术后肝静脉 (或副肝静脉 )压力均明显降低 ,术前肝静脉 (或副肝静脉 )压力为 (37.4± 5 .2 )cmH2 O(2 6 .3～ 5 2 .5cmH2 O) ,PTA或内支架置入术后即刻降为 (2 1.4± 4 .6 )cmH2 O(12 .4～ 31.2cmH2 O) (T =12 .34,P <0 .0 1)。 12例患者行改良式TIPS术 ,分流前门静脉主干压力为 (4 5 .2± 3.5 )cmH2 O ,分流后降至 (2 0 .4± 4 .1)cmH2 O。结论　肝静脉型Budd Chiari综合征可根据肝静脉闭塞和肝内侧更多还原

【Abstract】 Objective To investigate the interventional methods for Buddi-Chiari syndrome with occlusive hepatic veins and evaluate its therapeutic effects. Methods Thirty-six patients were included in this study (male 19 cases and female 17 cases). The liver functions were divided into Child A in 9 cases, Child B in 21 cases, and Child C in 6 cases. The interventional methods included recanalization of occlusive hepatic veins (by transjugular, transfemoral, and percutaneous transhepatic routes) and transjugular intrahepatic portosystemic shunt (TIPS). Results Successful recanalization of occlusive hepatic veins were carried out in 24 cases. The pressure of hepatic veins decreased from (37.4±5.2)cm H 2O to (21.4±4.6)cmH 2O after recanalization of occlusive hepatic veins (T=12.34, P<0.01). The intrahepatic shunts between portal vein and inferior vena cava were successfully built and good clinical responses were obtained in all of 12 patients. The main portal pressure decreased from (45.2±3.5) cmH 2O to (20.4±4.12) cmH 2O after the creation of shunt. Conclusions There are various interventional methods for treating Buddi-Chiari syndrome with occlusive hepatic veins. Correct selection of interventional methods can significantly decrease the pressures of hepatic vein and portal vein; and meliorate or eliminate the symptoms and signs.更多还原