球囊扩张治疗Budd-Chiari综合征合并下腔静脉血栓形成的疗效
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摘要
目的:总结预开通分期球囊扩张治疗Budd-Chiari综合征合(BCS)并下腔静脉血栓形成的疗效。方法:根据溶栓前是否小球囊预扩张,分为预扩组和对照组,比较两组疗效及围手术期并发症的发生情况;分析再发狭窄血栓形成的危险因素。结果:预扩组一期血栓完全清除率高于对照组(χ~2=4.68,P<0.05);预扩组溶栓治疗时间及住院时间均较对照组短(t_1=6.59,t_2=4.02,均P<0.01);两组间肺动脉栓塞发生率差异无统计学意义(χ~2=0.04,P>0.05)。单因素方差分析残余狭窄程度、闭塞类型是再发狭窄血栓形成的重要危险因素(χ■=8.05,χ■=5.33,P<0.05)。结论:腔内预开通分期球囊扩张治疗下腔静脉并发血栓形成安全、有效;残余狭窄、闭塞类型是复发的独立危险因素。
Objective:To evaluate the efficacy of intravenous preconditioning and phased balloon dilation in the treatment of patients with Budd-Chiari syndrome complicated with thrombosis at inferior vena cava.Methods:The patients were divided into pre-expansion group and control group by the requirement of small balloon dilation before thrombolysis.The curative effect and perioperative complications were compared between groups,and the risk factors for recurrence of thrombosis were analyzed.Results:The complete clearance rate of primary thrombus was higher in the pretreatment group than in the control group(χ~2=4.68,P<0.05).Patients undergone pre-expansion had shorter duration of thrombolytic use and hospital stay than those of the control group(t_1=6.59,t_2=4.02,P<0.01).There was no significant difference in the incidence of pulmonary embolism between groups(χ~2=0.04,P>0.05).One-way ANOVA indicated that residual stenosis and occlusion extent were significant risk factors for restenosis and thrombosis(χ■=8.05,χ■=5.33,P<0.05).Conclusion:Pre-conditioned and phased balloon dilatation is safe and effective in the treatment of thrombosis at inferior vena cava.Residual stenosis and occlusion type are independent risk factors for recurrence of stenosis and thrombosis.
Objective:To evaluate the efficacy of intravenous preconditioning and phased balloon dilation in the treatment of patients with Budd-Chiari syndrome complicated with thrombosis at inferior vena cava.Methods:The patients were divided into pre-expansion group and control group by the requirement of small balloon dilation before thrombolysis.The curative effect and perioperative complications were compared between groups,and the risk factors for recurrence of thrombosis were analyzed.Results:The complete clearance rate of primary thrombus was higher in the pretreatment group than in the control group(χ~2=4.68,P<0.05).Patients undergone pre-expansion had shorter duration of thrombolytic use and hospital stay than those of the control group(t_1=6.59,t_2=4.02,P<0.01).There was no significant difference in the incidence of pulmonary embolism between groups(χ~2=0.04,P>0.05).One-way ANOVA indicated that residual stenosis and occlusion extent were significant risk factors for restenosis and thrombosis(χ■=8.05,χ■=5.33,P<0.05).Conclusion:Pre-conditioned and phased balloon dilatation is safe and effective in the treatment of thrombosis at inferior vena cava.Residual stenosis and occlusion type are independent risk factors for recurrence of stenosis and thrombosis.
引文
[1] HUANG Q,SHEN B,ZHANG Q,et al.Comparison of long-term outcomes of endovascular management for membranous and segmental inferior vena cava obstruction in patients with primary Budd-Chiari syndrome[J].Circ Cardiovasc Interv,2016,9(3):e003104.
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[7] 汪忠镐,李震.布加综合征诊治历史、现状和发展趋势[J].中国实用外科杂志,2015,35(12):1261-1263.
[8] ZHANG W,WANG QZ,CHEN XW,et al.Budd-Chiari syndrome in China:A 30-year retrospective study on survival from a single center[J].World J Gastroenterol,2018,24(10):1134-1143.
[9] 王深明.血管外科学[M].北京:人民卫生出版社,2011:633.
[10] DING PX,LI YD,HAN XW,et al.Budd-Chiari syndrome with fresh inferior vena cava thrombosis:Agitation thrombolysis and balloon dilation[J].Vasa,2011,40(1):57-63.
[11] 高涌,余朝文,周为民,等.Budd-Chiari综合征的介入治疗[J].蚌埠医学院学报,2006,31(6):589-591.
[12] FU YF,XU H,WU Q,et al.Combined thrombus aspiration and recanalization in treating Budd-Chiari syndrome with inferior vena cava thrombosis[J].Radiol Med,2015,120(12):1094-1099.
[13] MENG X,LV Y,ZHANG B,et al.Endovascular management of Budd-Chiari syndrome with inferior vena cava thrombosis:A 14-year single-center retrospective report of 55 patients[J].J Vasc Interv Radiol,2016,27(10):1592-1603.
[14] WANG YL,DING PX,LI YD,et al.Comparative study of predilation with stent filter for Budd-Chiari syndrome with old IVC thrombosis:A nonrandomized prospective trial[J].Eur J Radiol,2012,81:1158-1164.
[15] JAGTAP N,SHARMA M,SINGH J,et al.Budd-Chiari syndrome:outcomes of endovascular intervention-A single-center experience[J].Indian J Gastroenterol,2017,36(3):209-216.
[16] 汪忠镐,李春民,李震,等.布-加综合征的进展与展望[J].临床肝胆病杂志,2011,27(2):113-115.
[2] KATHURIA R,SRIVASTAVA A,YACHHA SK,et al.Budd-Chiari syndrome in children:clinical features,percutaneous radiological intervention,and outcome[J].Eur J Gastroenterol Hepatol,2014,26(9):1030-1038.
[3] MITSUOKA H,SAITO T,HIGASHI S.Stepwise angioplasty and catheter directed thrombolysis for Budd-Chiari syndrome complicated with float-ing thrombus in inferior vena cava[J].AnnVasc Dis,2014,7(2):173-177.
[4] YONG G,SHIYUAN C,CHAOWEN Y.Applicability of different endovascular methods for treatment of refractory Budd-Chiari syndrome[J].Cell Biochem Biophys,2011,61(2):453-460.
[5] ALEXANDER C,ERICK MR,MARK S,et al.Diagnosis and management of Budd-Chiari syndrome:An update[J].Cardiovasc Intervent Radiol,2015,38(1):1-12.
[6] QI X,GUO X,FAN D.Difference in Budd-Chiari syndrome between the west and China[J].Hepatology,2015,62(2):656.
[7] 汪忠镐,李震.布加综合征诊治历史、现状和发展趋势[J].中国实用外科杂志,2015,35(12):1261-1263.
[8] ZHANG W,WANG QZ,CHEN XW,et al.Budd-Chiari syndrome in China:A 30-year retrospective study on survival from a single center[J].World J Gastroenterol,2018,24(10):1134-1143.
[9] 王深明.血管外科学[M].北京:人民卫生出版社,2011:633.
[10] DING PX,LI YD,HAN XW,et al.Budd-Chiari syndrome with fresh inferior vena cava thrombosis:Agitation thrombolysis and balloon dilation[J].Vasa,2011,40(1):57-63.
[11] 高涌,余朝文,周为民,等.Budd-Chiari综合征的介入治疗[J].蚌埠医学院学报,2006,31(6):589-591.
[12] FU YF,XU H,WU Q,et al.Combined thrombus aspiration and recanalization in treating Budd-Chiari syndrome with inferior vena cava thrombosis[J].Radiol Med,2015,120(12):1094-1099.
[13] MENG X,LV Y,ZHANG B,et al.Endovascular management of Budd-Chiari syndrome with inferior vena cava thrombosis:A 14-year single-center retrospective report of 55 patients[J].J Vasc Interv Radiol,2016,27(10):1592-1603.
[14] WANG YL,DING PX,LI YD,et al.Comparative study of predilation with stent filter for Budd-Chiari syndrome with old IVC thrombosis:A nonrandomized prospective trial[J].Eur J Radiol,2012,81:1158-1164.
[15] JAGTAP N,SHARMA M,SINGH J,et al.Budd-Chiari syndrome:outcomes of endovascular intervention-A single-center experience[J].Indian J Gastroenterol,2017,36(3):209-216.
[16] 汪忠镐,李春民,李震,等.布-加综合征的进展与展望[J].临床肝胆病杂志,2011,27(2):113-115.