布加綜合癥腔內(nèi)治療的長期隨訪

1

布加綜合征是指肝靜脈和(或)下腔靜脈狹窄或閉塞所致肝靜脈回流受阻而引發(fā)的一系列癥候群。2流行病學(xué)中國的布加綜合癥發(fā)病情況3分類

(汪忠鎬教授)

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4治療方法手術(shù)：根治術(shù)、肝移植等轉(zhuǎn)流手術(shù)Bypass血管腔內(nèi)治療

TIPS

血管腔內(nèi)溶栓球囊擴(kuò)張支架5臨床資料共計84例I型75例II型5例III型4例男54例、女30例，平均年齡43.6±5.7均腔內(nèi)手術(shù)治療67檢查與診斷彩色B超CTAMRADSA(黃金標(biāo)準(zhǔn))8CTA9MRA10DSA

下腔靜脈閉塞11DSA

肝靜脈閉塞12本組治療方法術(shù)前保守治療腔靜脈內(nèi)溶栓治療球囊擴(kuò)張支架支撐13（I）14（II）15肝靜脈擴(kuò)張支架術(shù)

（III）16下腔靜脈血栓17微量泵導(dǎo)管溶栓18治療結(jié)果操作成功率89.3%(75/84)植入41枚支架一例死于肺動脈栓塞19隨訪僅有54例得以長期隨訪計1-11年.47例保持療效7例下腔靜脈再次狹窄或閉塞

5例為支架狹窄或塌陷

2例單純擴(kuò)張?zhí)幵侏M窄

3

例死于其他疾病

202122支架移位23討論選擇腔內(nèi)治療：膜型狹窄或閉塞短段狹窄或閉塞(<5cm)無下腔靜脈血栓其他禁忌癥24討論是否支架支撐擴(kuò)張后再狹窄比例>25%隨訪中再狹窄病例選擇三節(jié)支架防止移位準(zhǔn)確定位術(shù)后定期X片評估支架形態(tài)25討論抗凝和隨訪建議抗凝一年以上

切實加強(qiáng)隨訪制度，有助于及時發(fā)現(xiàn)和解決相關(guān)并發(fā)癥。謝謝!EndovascularTreatmetFor

Budd-ChiariSyndrome

with

alongtermfollow-up

TongQiaoMDDepartmentofVascularSurgeryandRadiology,theAffiliatedDrumTowerHospitalofNanjingUniversityMedicalCollege,Nanjing,China28

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

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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