经皮开通治疗布加综合征合并下腔静脉血栓的单中心回顾性临床研究

发布时间：2018-11-06 07:44

【摘要】：研究背景:布加综合征合并下腔静脉血栓的病人占全部布加综合征病人的5%-20%。为了重建肝血液流出道并且降低肺栓塞的发生,各种治疗方式相继被报道。但是,怎样治疗这一亚组病人并没有统一的标准。研究目的:评估血管成形术联合支架植入结合抽栓溶栓治疗布加综合征合并下腔静脉血栓病人的安全性与有效性。实验材料及方法:回顾性分析了2000年4月至2014年8月期间连续收治的55例布加综合征合并下腔静脉血栓的病人。血栓抽吸后行经皮血管再通术,再通成功后放置下腔静脉支架。经增强CT和/或血栓抽吸发现下腔静脉血栓为新鲜血栓者,再通后给予尿激酶导管溶栓。实验结果:55例病人被确诊为布加综合征合并下腔静脉血栓。53例病人成功球囊开通(96.4%)。技术失败原因包括一例长段下腔静脉阻塞,一例广泛性下腔静脉纤维化。53例成功开通病人中,47例(88.7%)放置支架。23例病人血栓抽吸术成功,13例病人给予导管溶栓。中位随访时间为58个月(范围,8-180个月)。无一例发生肺栓塞。8个病人发生再狭窄,其中6例接受球囊扩张修正术。58.2%的下腔静脉血栓在一个月内消失。共有9例病人死亡(其中2例与布加综合征无关)。1、5、10年的累计通畅率分别为94%、89%、66%。术前的ALT和ALP水平是再狭窄的独立预测因素。1、5、10年的累计生存率分别为90%、86%、86%。Child-Pugh评分和再狭窄是生存的独立预测因素。实验结论:血管成形术联合支架植入结合抽栓溶栓治疗布加综合征合并下腔静脉血栓是安全有效的。此治疗方式下,病人的长期生存率和下腔静脉通畅率都较好。
[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.
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R575

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