【摘要】：研究背景:布加綜合征合并下腔靜脈血栓的病人占全部布加綜合征病人的5%-20%。為了重建肝血液流出道并且降低肺栓塞的發(fā)生,各種治療方式相繼被報(bào)道。但是,怎樣治療這一亞組病人并沒有統(tǒng)一的標(biāo)準(zhǔn)。研究目的:評(píng)估血管成形術(shù)聯(lián)合支架植入結(jié)合抽栓溶栓治療布加綜合征合并下腔靜脈血栓病人的安全性與有效性。實(shí)驗(yàn)材料及方法:回顧性分析了2000年4月至2014年8月期間連續(xù)收治的55例布加綜合征合并下腔靜脈血栓的病人。血栓抽吸后行經(jīng)皮血管再通術(shù),再通成功后放置下腔靜脈支架。經(jīng)增強(qiáng)CT和/或血栓抽吸發(fā)現(xiàn)下腔靜脈血栓為新鮮血栓者,再通后給予尿激酶導(dǎo)管溶栓。實(shí)驗(yàn)結(jié)果:55例病人被確診為布加綜合征合并下腔靜脈血栓。53例病人成功球囊開通(96.4%)。技術(shù)失敗原因包括一例長(zhǎng)段下腔靜脈阻塞,一例廣泛性下腔靜脈纖維化。53例成功開通病人中,47例(88.7%)放置支架。23例病人血栓抽吸術(shù)成功,13例病人給予導(dǎo)管溶栓。中位隨訪時(shí)間為58個(gè)月(范圍,8-180個(gè)月)。無(wú)一例發(fā)生肺栓塞。8個(gè)病人發(fā)生再狹窄,其中6例接受球囊擴(kuò)張修正術(shù)。58.2%的下腔靜脈血栓在一個(gè)月內(nèi)消失。共有9例病人死亡(其中2例與布加綜合征無(wú)關(guān))。1、5、10年的累計(jì)通暢率分別為94%、89%、66%。術(shù)前的ALT和ALP水平是再狹窄的獨(dú)立預(yù)測(cè)因素。1、5、10年的累計(jì)生存率分別為90%、86%、86%。Child-Pugh評(píng)分和再狹窄是生存的獨(dú)立預(yù)測(cè)因素。實(shí)驗(yàn)結(jié)論:血管成形術(shù)聯(lián)合支架植入結(jié)合抽栓溶栓治療布加綜合征合并下腔靜脈血栓是安全有效的。此治療方式下,病人的長(zhǎng)期生存率和下腔靜脈通暢率都較好。
[Abstract]:Background: Budd-Chiari syndrome with inferior vena cava thrombosis accounts for 5- 20 percent of all Budd-Chiari syndrome patients. In order to reconstruct the hepatic blood flow and reduce the incidence of pulmonary embolism, various treatment methods have been reported. However, there is no uniform standard on how to treat this subgroup of patients. Objective: to evaluate the safety and efficacy of angioplasty combined with stent implantation and thrombolytic therapy in patients with Budd Chiari syndrome complicated with inferior vena cava thrombosis. Materials and methods: 55 consecutive patients with Budd-Chiari syndrome complicated with inferior vena cava thrombosis from April 2000 to August 2014 were retrospectively analyzed. Percutaneous revascularization was performed after thrombus aspiration and stent placement in inferior vena cava (IVC) was performed after successful revascularization. After enhanced CT and / or thrombus aspiration, thrombus of inferior vena cava was found to be fresh thrombus, and thrombolytic therapy with urokinase catheter was given after recanalization. Results: 55 patients were diagnosed as Budd-Chiari syndrome with inferior vena cava thrombosis and 53 patients were successfully balloon opened (96.4%). The causes of technical failure included one long inferior vena cava obstruction and one extensive inferior vena cava fibrosis. Of the 53 patients who were successfully opened, 47 (88.7%) had stents placed. 13 patients were treated with catheter thrombolysis. The median follow-up time was 58 months (range, 8-180 months). No pulmonary embolism occurred. Restenosis occurred in 8 patients, 6 of them underwent balloon dilatation correction. 58.2% of inferior vena cava thrombosis disappeared within one month. A total of 9 patients died (2 of them were not associated with Budd-Chiari syndrome). Preoperative ALT and ALP levels were independent predictors of restenosis. The cumulative survival rate of 10 years was 90 / 8686. Child-Pugh score and restenosis were independent predictors of survival. Conclusion: angioplasty combined with stent implantation combined with thrombolytic thrombolysis is safe and effective in the treatment of Budd-Chiari syndrome with inferior vena cava thrombosis. The long-term survival rate and patency rate of inferior vena cava were better.
【學(xué)位授予單位】：第四軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R575

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