布加综合症腔内治疗的长期随访

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流行病学中国的布加综合症发病情况3分类

(汪忠镐教授)

I

II

III

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临床资料共计84例I型75例II型5例III型4例男54例、女30例，平均年龄43.6±5.7均腔内手术治疗67检查与诊断彩色B超CTAMRADSA(黄金标准)8CTA9MRA10DSA

下腔静脉闭塞11DSA

肝静脉闭塞12本组治疗方法术前保守治疗腔静脉内溶栓治疗球囊扩张支架支撑13（I）14（II）15肝静脉扩张支架术

（III）16下腔静脉血栓17微量泵导管溶栓18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19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

202122支架移位23讨论选择腔内治疗：膜型狭窄或闭塞短段狭窄或闭塞(<5cm)无下腔静脉血栓其他禁忌症24讨论是否支架支撑扩张后再狭窄比例>25%随访中再狭窄病例选择三节支架防止移位准确定位术后定期X片评估支架形态25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。谢谢!EndovascularTreatmetFor

Budd-ChiariSyndrome

with

alongtermfollow-up

TongQiaoMDDepartmentofVascularSurgeryandRadiology,theAffiliatedDrumTowerHospitalofNanjingUniversityMedicalCollege,Nanjing,China28

Budd-Chiarisyndrome(BCS)wasararediseasecharacterizedbyobstructionofoutflowinhepaticvein(HV)and/orinferiorvenacava(IVC).29Epidemiology30CLASSIFICATION(ProfessorWANG)

I

II

III

31TreatmentClassificationSurgeryRadicalsurgery、LivertransplantationBypassInterventionalprocedure

TIPSEndovascularthrombolysisBalloonStent32InformationTotal84cases75patientswithBCS（TypeI）5patientswithBCS（TypeII）4patientswithBCS（TypeIII）Averageagewas43.6±5.7yearsEndovascularprocedure54malesand30females.3334ExaminationUltrasoundscanCTAMRADSA(GoldStandard)35CTA36MRA37DSA

Obstructionofinferiorvenacava(IVC)38DSA

Hepaticvein(HV)occlusion39TherapychoiceConservativetreatmentEndovascularthrombolysis(ThrombusinIVC)PTAStents.

40（I）41（II）42Hepaticveindilation（III）43ThrombusinIVC44ContinuousInfusion45ResultsTechnicalsuccesswasachievedin89.3%(75/84)41stentsdeliveredOnecasedieofPEintwodays46FollowupUnfortunately,only54caseswerefollowupandexaminedin1-11years.Fullrecoveryin47casesRestenosisorreocclusionin7casesStentcollapseorcompressed5casesstentmigration1cases

3casesdieofmalignantdisease

474849Stentmigration50DiscussionPreferendovascular…membranouslesionshortsegmentocclusion(<5cm)withoutthrombusOthercontraindicationforsurgery51

DiscussionStentornotrecontraction>25%ThreesegmentsstentExactlocationRe-dilatedcasesRegularlyX-raycheckforstent52DiscussionAnticoagulationandFollow-up

Anticoagula