改良经颈静脉肝内门体分流术治疗布-加综合征所致顽固性腹水效果分析

目的 探讨改良经颈静脉肝内门体分流术(TIPS)治疗布-加综合征(BCS)所致顽固性腹水患者的效果.方法 回顾性分析2015年6月至2019年7月徐州医科大学附属医院采用改良TIPS治疗的31例BCS所致顽固性腹水患者临床资料.其中早期接受改良TIPS治疗17例(肝静脉广泛阻塞8例,残存肝静脉代偿不全9例),肝静脉开通...     

三维可视化技术在经颈静脉肝内门-体静脉分流术治疗肝静脉广泛闭塞布加综合征中的初步应用

目的 评价三维可视化技术在经颈静脉肝内门-体静脉分流术(TIPS)治疗肝静脉广泛闭塞布加综合征(BCS)中的应用价值.方法 搜集21例肝静脉广泛闭塞BCS患者,男11例,女10例,平均年龄(39.7±14.3)岁.选取患者磁共振血管成像(MRA)或CT血管成像(CTA)扫描数据,以医学数字成像和通信(DICOM)文件格...     

改良式经颈静脉肝内门腔静脉分流术治疗肝静脉闭塞型Buddi-Chiari 综合征

目的阐述改良式经颈静脉肝内门腔静脉分流术(TIPS)的技术步骤和评价其对肝静脉闭塞型Buddi-Chiari综合征的治疗效果.方法 11例被诊断为Buddi-Chiari综合征的患者,经影像学证实为肝静脉广泛狭窄和闭塞后,接受改良式TIPS技术治疗,TIPS改良技术的关键在于假想肝静脉通道的设计与建立;术后对其门脉系统压力变化、分流道血流改变及内支架开通状况进行了24个月的随访.结果 11例患者全部成功地建立肝内门静脉-下腔静脉分流通道,临床症状得到改善;门静脉主干压力由分流前的平均(4.62±0.52) kPa (1 kPa=10.2 cm H2O)下降至分流术后的(2.16±0.21) kPa;术后24个月随访,分流道血液最大流率(Vmax)为(56.2±3.50) cm/s,内支架通畅7(7/11)例.结论改良式TIPS技术具有高技术成功率,为肝静脉闭塞型Buddi-Chiari综合征患者提供了新的治疗手段.     

提高经颈静脉肝内门体分流术治疗门静脉闭塞技术成功率的辅助靶标手段北大核心CSCD

目的 探讨提高经颈静脉肝内门体分流术(TIPS)治疗门静脉闭塞(PVO)技术成功率的辅助靶标手段及其安全性和有效性。方法 纳入22例应用辅助靶标手段行TIPS治疗的PVO患者。其中11例应用经皮经肝门静脉靶标(PTPVT)技术,10例应用肝动脉导丝靶标(HAT)技术,1例两种辅助手段联合应用。结果 1例失败,技术成功率为95.5%(21/22)。成功建立分流道患者门静脉压力梯度(PPG)由(28.4±7.7) mmHg(1 mmHg=0.133 kPa)降至(12.1±4.5) mmHg(P<0.01)。术中未出现危及生命的严重并发症。中位随访时间14.9个月,术后累积支架通畅率为81.8%(18/22);6例发生静脉曲张再出血,累积再出血率为27.3%;3例出现肝性脑病;1例因发生感染死亡。结论 TIPS是治疗PVO的安全有效方法,辅助靶标手段可提高TIPS的技术成功率。     

经颈静脉肝内门腔分流术治疗复杂型Budd-Chiari综合征

目的　探讨和评价经颈静脉肝内门腔静脉分流术（TIPS）治疗复杂型Budd-Chiari综合征（BCS）并门脉高压的临床应用价值。方法　患者男4例，女1例，平均年龄33岁，均有不同程度的食管胃底静脉曲张，4例有上消化道出血史，2例伴有腹水。经下腔静脉相当于右肝静脉开口部进针穿刺门脉行TIPS治疗。结果　5例均获成功。门脉压力由术前平均（4.7±1.3）kPa降至（3.5±1.5）kPa（1kPa=7.5mmHg）。术后24h1例死于心肺衰竭；术后3周1例死于肝功能衰竭。另3例平均随访64个月，肝功能均正常。2例于术后6、9个月均有分流道狭窄，并行二次介入治疗。结论　TIPS是解决复杂型BCS伴门脉高压的一种安全有效的治疗方法。     

经颈静脉肝内门-体静脉分流术的临床应用

肝硬化门脉高压是我国常见病、多发病 ,治疗方法较多 ,包括外科门 -腔静脉分流术加脾切除术、经皮穿刺门静脉行曲张静脉栓塞术、经内镜直接对曲张静脉行硬化、套扎术等。外科手术创伤大、并发症多 ,术后再狭窄率高 ,况且部分患者不愿意接受或难以承受外科手术 ;而曲张静脉栓塞、硬化、套扎等方法未能真正减轻门静脉压力 ,远期疗效差 ,再出血率高。 1989年Richter等首次经颈静脉肝内门 体静脉分流术 (TIPS)治疗肝硬化门静脉高压 ,3年后我国首例TIPS在临床获得成功 ,10多年来随着影像设备及介入器材的不断发展 ,尤其是介入医生的卧薪尝胆…     

经颈静脉肝内门体静脉分流术的回顾与展望

在征服门脉高压所致的严重并发症的道路上 ,过去 10年的进步是历史性的。最引人注目的是非手术方法或微创性介入技术 ,尤其是经颈静脉肝内门体静脉分流术 (ＴＩＰＳ)的10年发展倍受关注。笔者试以所掌握的资料及个人经验对其作一简要的回顾与展望。ＴＩＰＳ的发展196 7年放射学家Ｈａｎａｆｅｅ介绍了经颈静脉及肝静脉达到肝内胆道的造影方法 ,以避免经肝包膜穿刺的出血 ,它对胆道造影本身的影响不大 ,但激发了介入放射学家去用类似的微创技术进入门脉 ,达到门体静脉分流的目的。Ｒｏｅｓｃｈ和Ｈａｎａｆｅｅ先用不同的实验模型建立经颈静…     

经颈静脉肝内门体分流术治疗门静脉血栓形成伴急性消化道大出血效果评价北大核心CSCD

目的 评价经颈静脉肝内门体分流术(TIPS)治疗门静脉血栓形成(PVT)伴消化道大出血的可行性及临床效果。方法 回顾性分析2015年3月至2017年3月采用TIPS术治疗的18例PVT伴消化道大出血患者临床资料,观察围手术期并发症发生率、再出血率、血栓开通情况、肝性脑病发生率、支架中远期通畅率。结果 所有患者均在消化道大出血72 h内成功完成TIPS术,手术成功率100%。围手术期死亡率5.5%(1/18),术后发生Ⅰ~Ⅱ级肝性脑病5例(27.8%,5/18)。术后随访6~24个月,平均12.4个月,PVT完全消失6例,明显减少7例,无明显进展4例;所有患者支架均通畅,2例出现支架内狭窄,其中1例无出血,未予处理,1例术后8个月再出血,予球囊扩张修复术后出血停止。结论 TIPS术治疗PVT伴急性消化道大出血安全、有效,值得推广。     

经颈静脉肝内门体静脉分流术治疗肝硬化顽固性腹水的研究现状

经颈静脉肝内门体静脉分流术 (TIPS)最初主要用于控制或预防肝硬化门静脉高压性上消化道出血 ,然而 ,在临床上常可观察到TIPS在有效控制上消化道出血同时 ,对缓解肝硬化腹水也具有重要作用。顽固性腹水是失代偿期肝硬化的严重合并症 ,其临床预后极差 ,1、2年病死率分别超过 5 0     

改良式TIPS治疗肝静脉广泛阻塞型布-加综合征的近期疗效

目的 观察改良式TIPS治疗肝静脉广泛阻塞型布-加综合征(BCS)的近期疗效.方法 7例肝静脉广泛阻塞型BCS患者,使用改良术式TIPS治疗,其中2例为急性,5例为亚急性或慢性.术后给予正规抗凝治疗,并用彩色多普勒超声随访疗效.结果 7例肝静脉广泛阻塞型BCS均成功完成改良式TIPS,7例患者共置入12枚支架(覆膜支架...     

布加综合征合并肝静脉血栓介入治疗的疗效观察

目的 评价布加综合征合并肝静脉血栓介入治疗的临床效果.方法 25例布加综合征合并肝静脉血栓形成的患者,均施行经导管尿激酶溶栓术、球囊扩张术和(或)支架置入术,术后随访采用肝脏超声检查,观察肝静脉、下腔静脉通畅情况及血栓有无复发.介入治疗前后肝静脉-右心房、下腔静脉-右心房压差的比较采用配对t检验.结果 治疗成功23例,其中血栓完全溶解18例,部分溶解5例,肝静脉及下腔静脉血流通畅,肝静脉-右心房压差由术前平均(29±7)cm H2O(1 cm H2O＝0.098 kPa)下降至术后平均(8±3)cm H2O(t=13.7,P＜0.01),下腔静脉-右心房压差由术前平均(19±4)cm H2O下降至术后平均(5±2)cm H2O(t=13.3,P＜0.01);不成功2例.23例患者随访1～42个月,平均(18±10)个月,死亡1例,肝静脉再狭窄2例,经再次球囊扩张治疗成功,其余20例无肝静脉再狭窄及血栓复发.结论 布加综合征合并肝静脉血栓的介入治疗可取得较好临床效果.

Abstract：

Objective To evaluate the effect of interventional therapy for Budd-Chiari syndrome with hepatic vein thrombosis. Methods Twenty-five patients with Budd-Chiari syndrome complicated with hepatic vein thrombosis underwent catheter-directed urokinase thrombolysis, balloon dilation and/or stent placement. During follow-up, re-thrombosis and patency of the recanalized hepatic vein and inferior vena cava were evaluated by liver ultrasound. The pressure gradient of hepatic vein-right atrium or inferior vena cava-right atrium before and after interventional treatment was compared with paired t-test. ResultsTechnical success was obtained in 23 patients. Complete resolution and partial resolution of the thrombi were accomplished in 18 cases and 5 cases, respectively. The recanalized hepatic veins and inferior vena cava were patent. The mean pressure gradient of hepatic vein-right atrium dropped from (29±7) cm H2O to (8±3) cm H2O (1 cm H2O＝0.098 kPa) after the interventional treatment (t=13.7,P<0.01). The mean pressure gradient of inferior vena cava-right atrium dropped from (19±4) cm H2O to (5±2) cm H2O after the interventional treatment (t=13.3, P<0.01). Failures occurred in 2 patients. Over the follow-up period of 1 to 42 months[(18±10) months]after interventional treatment in the 23 patients, one late death occurred. Restenoses of hepatic veins were found in 2 patients, which were all redilated successfully. Neither restenosis of hepatic vein nor recurrence of thrombosis was found in the other 20 patients. Conclusion Interventional therapy could be effectively performed for the treatment of Budd-Chiari syndrome with hepatic vein thrombosis.     

Therapeutic hepatic vein angioplasty for Budd-Chiari syndrome

The authors report a case of Budd-Chiari syndrome treated by percutaneous transluminal angioplasty (PTA). In this case, the occlusion of three major hepatic veins with a big collateral to the inferior vena cava via the right inferior hepatic vein (RIHV) and stenosis of the ostium of RIHV were seen. We performed successful PTA of this stenosis.     

Accessory hepatic vein recanalization for treatment of Budd-Chiari syndrome due to long-segment obstruction of the hepatic vein: initial clinical experience

PURPOSE

We aimed to investigate the feasibility and effectiveness of accessory hepatic vein recanalization (balloon dilatation/stent insertion) for patients with Budd-Chiari syndrome (BCS) due to long-segment obstruction of the hepatic vein.

METHODS

From March 2010 to December 2013, 20 consecutive patients with BCS, due to long-segment obstruction of three hepatic veins, treated with accessory hepatic vein recanalization (11 males, 9 females; mean age, 33.4±10.9 years; range, 22–56 years) were included in this retrospective study. Data on technical success, clinical success, and follow-up were collected and analyzed.

RESULTS

Technical and clinical success was achieved in all patients. Each patient was managed with a single accessory hepatic vein recanalization procedure. No procedure-related complications occurred. The diameter of the accessory hepatic vein was 8.45±1.47 mm (6–11 mm) at the stem, and there were many collateral circulations between the hepatic vein and the accessory hepatic vein. The mean pressure of accessory hepatic vein decreased from 47.50±5.59 cm H₂O before treatment to 28.80±3.47 cm H₂O after treatment (P < 0.001). Abnormal levels of total bilirubin, albumin, aspartate aminotransferase, and alanine transaminase improved after the treatment. During the follow-up, three patients experienced restenosis or stenting of the accessory hepatic vein.

CONCLUSIONS

In BCS due to long-segment obstruction of the hepatic veins, it is important to confirm whether there is a compensatory accessory hepatic vein. For patients with a compensatory but obstructed accessory hepatic vein, recanalization is a simple, safe, and effective treatment option.Budd-Chiari syndrome (BCS) is a rare disease characterized by hepatic venous outflow obstruction at the level of the hepatic vein (HV) or inferior vena cava (IVC) resulting in portal hypertension (1, 2). Thrombus is the most frequent cause in Western countries, whereas membranous webs are more common in Asia (2). HV recanalization has been reported as a simple, effective, and safe method for patients with BCS due to hepatic venous obstruction (1, 2). However, if the patients display long-segment obstruction of the HV, recanalization is always difficult with a high failure rate of 31%–100% (1, 2). Even when successfully managed, there is a risk of HV reobstruction after treatment (2).Various treatments, including transjugular intrahepatic portosystemic shunt (TIPS), surgical shunts, and liver transplantation have been described as potential treatment options for BCS (3–6). However, there are only a few studies on accessory hepatic vein (AHV) recanalization for treatment of BCS. In this study, we present our initial clinical results of AHV recanalization in 20 patients with BCS due to long-segment obstruction of HV.     

肝静脉阻塞型布-加综合征误诊误治原因分析

目的 探讨肝静脉阻塞型布-加综合征(HVBCS)临床症状、影像学特征及误治分析.方法 13例误治的HVBCS患者,5例行下腔静脉球囊扩张术,8例行下腔静脉支架植入.分析13例患者临床症状、体征及影像学资料,经DSA造影进一步证实后予肝静脉成形术.结果 所有患者均有不同程度的门静脉高压表现,无明显下腔静脉阻塞症状.CT或(和)MRI示肝尾状叶明显增大,DSA示下腔静脉呈外压性狭窄.13例均成功实施肝静脉成形术;其中4例行单纯PTA,9例行PTA 支架,术后所有患者临床症状与体征完全消失或明显改善.结论 HVBCS的下腔静脉狭窄不是其本身病变,而是肝尾状叶代偿性增大压迫所致.肝静脉成形术是一种正确的、安全、有效的治疗方法.     

副肝静脉成形术在Budd-Chiari综合征治疗中的应用

目的 评价副肝静脉成形术[经皮腔内血管成形术（PTA）及支架置入术]在Budd-Chiari综合征（BCS）介入治疗中的价值。方法 本组14例BCS患者均为肝静脉，副肝静脉狭窄或闭塞，主要症状和体征为腹胀，腹痛，腹水，肝脾肿大等，均接受了副肝静脉成形术，采用经股静脉或经颈静脉和经皮经副肝静脉途径开通副肝静脉的方法。结果 14例BCS开通副肝静脉均获得成功，未发生严重并发症，术后临床治愈7例，有效5例，无效2例。随访3-48个月。3例PTA后再狭窄（支架内血栓形成1例），1例术后2个月死于消化道大出血。结论 开通副肝静脉有着与开通肝静脉同等的治疗价值。易于操作，且更加安全，适应证为：（1）肝静脉和副肝静脉同时闭塞，而且肝静脉为节段性闭塞；（2）副肝静脉明显代偿性扩张，其管径大于8mm。