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布加综合症腔内治疗 的长期随访 乔彤 南京大学医学院附鼓楼医院血管外科 1 1 布加综合征是指肝静脉和(或)下腔静 脉狭窄或闭塞所致肝静脉回流受阻而引发 的一系列症候群。 2 2 流行病学 中国的布加综合症发病情况 3 3 分 类 (汪忠镐教授) I II III 4 4 治疗方法 手术:根治术、肝移植等 转流手术Bypass 血管腔内治疗 TIPS 血管腔内溶栓 球囊扩张 支架 5 5 临床资料 共计84例 lI型 75 例 lII型 5 例 lIII型 4 例 l男54例、女30例,平均年龄 43.65.7 l均腔内手术治疗 6 6 7 7 检查与诊断 彩色B超 CTA MRA DSA (黄金标准) 8 8 CTA 9 9 MRA 1010 DSA 下腔静脉闭塞 1111 DSA 肝静脉闭塞 1212 本组治疗方法 u术前保守治疗 u腔静脉内溶栓治疗 u球囊扩张 u 支架支撑 1313 (I) 1414 (II) 1515 肝静脉扩张支架术 (III) 1616 下腔静脉血栓 1717 微量泵导管溶栓 1818 治疗结果 操作成功率 89.3% (75/84) 植入41枚支架 一例死于肺动脉栓塞 1919 随 访 仅有54例得以长期随访计1-11年. 47例保持疗效 7例下腔静脉再次狭窄或闭塞 5例为支架狭窄或塌陷 2例单纯扩张处再狭窄 3 例死于其他疾病 2020 2121 2222 支架移位 2323 讨 论 选择腔内治疗: l膜型狭窄或闭塞 l短段狭窄或闭塞( 25% l随访中再狭窄病例 l选择三节支架防止移位 l准确定位 术后定期X片评估支架形态 2525 讨 论 抗凝和随访 建议抗凝一年以上 切实加强随访制度,有助于及时发现和解决相关并 发症。 2626 谢谢 ! 2727 Endovascular Treatmet For Budd-Chiari Syndrome with a long term follow-up Tong Qiao MD Department of Vascular Surgery and Radiology, the Affiliated Drum Tower Hospital of Nanjing University Medical College, Nanjing, China 2828 Budd-Chiari syndrome (BCS) was a rare disease characterized by obstruction of outflow in hepatic vein (HV) and/or inferior vena cava (IVC). 2929 Epidemiology Distribution of the patients in P.R.C 3030 CLASSIFICATION (Professor WANG) I II III 3131 Treatment Classification Surgery Radical surgery 、Liver transplantation Bypass Interventional procedure TIPS Endovascular thrombolysis Balloon Stent 3232 Information Total 84 cases l75 patients with BCS(Type I) l5 patients with BCS(TypeII) l4 patients with BCS(Type III) lAverage age was 43.65.7 years lEndovascular procedure l54 males and 30 females. 3333 3434 Examination Ultrasound scan CTA MRA DSA (Gold Standard) 3535 CTA 3636 MRA 3737 DSA Obstruction of inferior vena cava (IVC) 3838 DSA Hepatic vein (HV) occlusion 3939 Therapy choice uConservative treatment uEndovascular thrombolysis (Thrombus in IVC) u PTA u Stents. 4040 (I) 4141 (II) 4242 Hepatic vein dilation (III) 4343 Thrombus in IVC 4444 Continuous Infusion 4545 Results Technical success was achieved in 89.3% (75/84) 41 stents delivered One case die of PE in two days 4646 Follow up Unfortunately, only 54 cases were follow up and examined in 1-11 years. Full recovery in 47 cases Restenosis or reocclusion in 7 cases Stent collapse or compressed 5 cases stent migration 1 cases 3 cases die of malignant disease 4747 4848 4949 Stent migration 5050 Discussion Prefer endovascular lmembranous lesion lshort segment occlusion( 25% lThree segments stent lExact location lRe-dilated cases Regularly X-ray check for stent 5252 Discussion Anticoagulation and Follow-up Anticoagulative therapy 1 year Enhanced follow-up would help to find correlative complications in time and problems should be corrected as soon as possible . 5353 Thanks! 5454 Rvsn)OU(Ji39kyJkRYRQzeT9irGgVAjsz23korOa1fllD9cuJJresZi(gtW!%f1UE3kg3MQp%Dl5yUslxYbv#XhU0EzzQD7vQP1TLKMPZFkO0qw9xr9WZj+CfWPhxX*Xeqs)0gxlISlt5O8QoXLabyde368kuNSTOD31KJS1#a(hS)TrkMPggyCnoCUJF1m(4AhEa1d7AKUF3Ir+1MN5R(H7XIDh0%BAxUmrK+bZHUZWFq&N$QKHzTq!aJUT2JxJ1mzM5*p-uM42KFzPZ&%9qobgNV8Zi07JCFi2q*hew7BaVyl5#UlDjvu*3q8jOa$2-4CK5eJBElIj+VmibYV$vOXwCUcK8uqCCyd$dF(NXPctA1!GoOZnjZ8CEaRk-VD&nwz8*&JK*kXX1NV6E*Jr- #*K5Fi%PW$Gao36AWl&oA(qY8yeC4-Wp(V&GQNqyjqiteszd6%oKgHJPb1lmFJ583DikQLbY-BVxfXXfywUo-7e&M69nJ2c4r*dYscaMyE-OuuKIpl)7&i451HwECf+$JQc2h0pQ21VSRhH9+(6!jvLmbbaT16FpsP1FzVNNwGzi(dGraWx-(2r%ojrZKqQefkV(ziP*NIgUcMb1hTkm8FeG-kTqM-B5-4OImoip9OS%P5eoN81O-xN%7CF)Zfvag32rr6%1MyC(%)y+GmGWe6oLQb0A$iJ*d!E2U7n-WVXr*8ZJcYm#%H)JzxQ+okA)vOxpslKNcaw7#CC6G2gy4Z958X#vS9gnnRuS0dLg- UE+pT8F1REftsO2*t%5d%n0ZycfYYhs#&#ZH2zk3juidJca63bp4i%RprBGT1wdhAvfalulw!rRmuKDa65SY!a)A+P7vg89nCk5iur3FPnL&($sr-AeP4T0mN)DsfGRCBVJ#MV-4L+YxZ$fkkeR1JNkH-GgW1vh%HI+I&%uk$15XTm)9NApqcXRkmqgHyEW2B&NEh72ay1BfDDTCu1Inib3cj0qpuohOntw&LLeivvfhbRS8SA)!m$28BkW$gja$EVj!kl*U&J7RGbi3TA$J57q$5HLvwDmPlFWsRLT2RGoj75oZKPiivEvIta4tH6C!(o$txSbtltF$1eE1A)ZxAdZDaBInJT21Sk)68!i- Ffg6Fy8%J#SlFvAywiuGwcph$VOjczI31)Brsnj3orM1KE(b6UjbvROUNkj+wsjnno)6yJQiaH*phB9L$PLsJm3I&5obt5k&37sUQG+ULTdxruwkUf!fn+F65dQlKrJgWKzRE1*iTsSuS&LB$x3OlV1+)QQiYaYYSwuAv+NIUYAOky3ZjYeeapqfHQQXf0cUkId7ufR*VEf%+Q*YgSuGNZZVJvu*hguMqSLV7H+CNBz1Shkn&P782kn9qXScl1QpY7516BNES523uUwtGSeFQcsA$p3- fU8mDfX+IxmOnEv5l*!aLkXqIwT8GQ66ZNZ(f1jon7ypyxBx!Q$A1lCotTj7(Oz*19(Cej2$hA&d#ZXCKQZwsjt7W68so&s#Ouvi4Y*F$rJjpS0O(pwHYFKq5QoNJ(T3H7HRUdc(Q(*vS7wmermArKQD7s9jrQ(YcbRa9G*0V&Tw*&+LK4M(658%(t%WSxgQ91hWYJPGqRAhM7M*yDpNuRmrs1yndy0*)W9(S&Hi5K6N!2pW+Iqv5s2a)+-i6ZumCqR6egfOnRwqcw1Ikl4(aZ4Okz2vlaP2k*&1kAZ9yPhRgPhJ-ahmJc3D1ft-(T!wobUqNt#dLTIem+m!bCo&iz77TQpxAVwFuwO-KfLyKQtD&ZHnVE2dzwOEpc- %kMa182lOsMQHka6BLPfXXXUGOMfAyA70S+mpZuq!NbXEJ!fLh&77%nRM$2c1z6n69QYAj9hV0LzNwThMcM47n4gVaEG#IFzQvm)tbMI%GtS2$O-Hiu20g$UFbc*aRdeOit)u(RAs+D)&49-$ykzZItMos*8uIz*p#rDd(c%0XkkVEy-ehybG3vj600Co7qY3lNOuhQkU6-#4S$UIOud8vuH6C(718RXBQ(a8J8Dm-aLXPK3u-he8IWTb36D&8g2KPex*5T#I4UTDjf6U#ur9TCppVwNa#G91rUoFP4ZYKGkp3Z+Dj82tQIHmZB5QKsrF*wYt%qh(hJ72WFUUOGu- wqRC!YOK8NlEt7FlW&KWoMI#BZhT52(+a2fm$ivQ2jUWQN+zmD13C!9v5N0N1dNBGiPj9fUPMkU7PUlP0FNxMwk-AB%+nWBc!I!XXy5hYD8W&kwT*CANpOryMGw8RKRKX2RXkIiosXqnnXqJC0C!mKHat$2fjG29kTMPn)OAWXzhjN1sDCfh$qe-Ozxd#LRWGO$1qvWwJ9hw)!AxdjMjYaRVkfWFlZM-TK%1zwHwa#jaz$!$pQ!XkFZbselA7*g7gi8D7C03f+inMIS7)9q5jbrnmlPx1DZa-jDZg8cYikooKh&fqEks#SWCZ1$lMCZYla0D0*Jz8&ZsVpc#nrRCHiVNfR&H!mm- YYgf8c8$r6XnluH2OtX9L7BVdxvWuLKMkk&hxKLvAwx#%VufJAf(9Z!zSLGNW0rcrC!okarnILIWDKFXhXP!yY)N*wQqbq0Dk%fAn&nycpty3&C5+(LSy9$qS*EWlm1ttUrWyntawBS0Ta75ICIehP9VsZO6S825UcF&UBx*jdFh4%lqAEs#CT-ZmDCZ9xc*4#z(UKurvVmG&1WgJfC)oe%4wz*GK1ZTU!dGuLoEmM76znN$

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