腔内导管搅拌溶栓在布-加综合征合并下腔静脉及肝静脉血栓中的应用

孙龙; 张荣杰; 胡春芳; 郝迎学

doi:10.11659/jjssx.03E023019

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腔内导管搅拌溶栓在布-加综合征合并下腔静脉及肝静脉血栓中的应用

血管专栏 | 更新时间：2023-11-24

- 腔内导管搅拌溶栓在布-加综合征合并下腔静脉及肝静脉血栓中的应用
- Application of endovascular catheter-stirring thrombolysis in Budd-Chiari syndrome combined with inferior vena cava and hepatic vein thromboses
- 局解手术学杂志 2023年32卷第11期页码：963-967
- 作者机构：
  
  陆军军医大学第一附属医院血管外科，重庆 400038
- 作者简介：
  
  郝迎学，E-mail：haoyingxue@hotmail.com
- 基金信息：
  
  陆军军医大学科技创新能力提升专项项目(2021XJS13)
- DOI：10.11659/jjssx.03E023019
  中图分类号： R654.4
- 纸质出版日期：2023-11-25，
  
  收稿日期：2023-03-03，
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孙龙,张荣杰,胡春芳等.腔内导管搅拌溶栓在布-加综合征合并下腔静脉及肝静脉血栓中的应用[J].局解手术学杂志,2023,32(11):963-967.

SUN Long,ZHANG Rong-jie,HU Chun-fang,et al.Application of endovascular catheter-stirring thrombolysis in Budd-Chiari syndrome combined with inferior vena cava and hepatic vein thromboses[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2023,32(11):963-967.
孙龙,张荣杰,胡春芳等.腔内导管搅拌溶栓在布-加综合征合并下腔静脉及肝静脉血栓中的应用[J].局解手术学杂志,2023,32(11):963-967. DOI： 10.11659/jjssx.03E023019.

SUN Long,ZHANG Rong-jie,HU Chun-fang,et al.Application of endovascular catheter-stirring thrombolysis in Budd-Chiari syndrome combined with inferior vena cava and hepatic vein thromboses[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2023,32(11):963-967. DOI： 10.11659/jjssx.03E023019.

摘要

目的

分析腔内导管搅拌溶栓治疗伴下腔静脉及肝静脉新鲜血栓的布-加综合征（BCS）的安全性和有效性。

方法

回顾分析我院22例BCS伴下腔静脉及肝静脉新鲜血栓患者的临床资料，患者均接受经导管搅栓溶栓、血栓抽吸及经皮血管成形术等腔内介入治疗。统计患者治疗后血栓清除及并发症发生情况。

结果

21例患者下腔静脉及肝静脉新鲜血栓完全清除，1例患者溶栓后消化道出血，终止治疗，且随访期间失访。22例患者围术期均未出现肺栓塞症状。随访期间，21例患者下腔静脉及肝静脉血流通畅，无血栓形成、明显狭窄及肺动脉栓塞发生，患者临床症状及体征完全消失，11例植入支架的患者支架无明显移位或断裂。

结论

腔内导管搅拌溶栓治疗BCS合并下腔静脉及肝静脉新鲜血栓安全有效，可有效清除下腔静脉及肝静脉新鲜血栓，避免肺动脉栓塞的发生。

Abstract

Objective

To explore the safety and efficacy of endovascular catheter-stirring thrombolysis in the treatment of Budd-Chiari syndrome （BCS） with fresh thrombi in the inferior vena cava and hepatic vein.

Methods

The clinical data of 22 patients with BCS and fresh thrombi in the inferior vena cava and hepatic vein were retrospectively analyzed， and all patients received endovascular interventions including catheter-stirring thrombolysis， thrombi aspiration and percutaneous transluminal angioplasty. The clearance of thrombi and occurrence of complications after operation were collected.

Results

The fresh thrombi in the inferior vena cava and hepatic vein for 21 patients were completely cleared， and 1 patient terminated the treatment for gastrointestinal bleeding after thrombolysis， and was lost to follow-up. There was no perioperative pulmonary embolism in 22 patients. During the follow-up， the inferior vena cava and hepatic vein of 21 patients had smooth blood flow and without thrombosis， obvious stenosis or pulmonary embolism， and the clinical symptoms and signs of the patients completely disappeared； and 11 patients who underwent stenting had no significant displacement or rupture of the stents.

Conclusion

Endovascular catheter-stirring thrombolysis in the treatment of BCS combined with fresh thrombi in the inferior vena cava and hepatic vein is safe and effective， which can clear the fresh thrombi in the inferior vena cava and hepatic veins effectively and avoid the occurrence of pulmonary embolism.

关键词

布-加综合征腔内介入技术导管搅栓溶栓血栓抽吸静脉血栓

Keywords

Budd-Chiari syndromeendovascular interventional techniquecatheter-stirring thrombolysisthrombi aspirationvenous thrombosis

references

DeLeve LD，Valla DC，Garcia-Tsao G，et al.Vascular disorders of the liver［J］.Hepatology，2009，49（5）：1729-1764.doi：10.1002/hep.22772http://dx.doi.org/10.1002/hep.22772.

Garcia-Pagán JC，Valla DC.Primary Budd-Chiari syndrome［J］.N Engl J Med，2023，388（14）：1307-1316.doi：10.1056/NEJMra2207738http://dx.doi.org/10.1056/NEJMra2207738.

Li T，Zhang WW，Bai W，et al.Warfarin anticoagulation before angioplasty relieves thrombus burden in Budd-Chiari syndrome caused by inferior vena cava anatomic obstruction［J］.J Vasc Surg，2010，52（5）：1242-1245.doi：10.1016/j.jvs.2010.05.098http://dx.doi.org/10.1016/j.jvs.2010.05.098.

Zhang QQ，Xu H，Zu MH，et al.Strategy and long-term outcomes of endovascular treatment for Budd-Chiari syndrome complicated by inferior vena caval thrombosis［J］.Eur J Vasc Endovasc Surg，2014，47（5）：550-557.doi：10.1016/j.ejvs.2014.01.014http://dx.doi.org/10.1016/j.ejvs.2014.01.014.

Ding PX，He X，Han XW，et al.An individualised strategy and long-term outcomes of endovascular treatment of Budd-Chiari syndrome complicated by inferior vena cava thrombosis［J］.Eur J Vasc Endovasc Surg，2018，55（4）：545-553.doi：10.1016/j.ejvs.2017.12.016http://dx.doi.org/10.1016/j.ejvs.2017.12.016.

He XH，Li WT，Peng WJ，et al.Anticoagulation with warfarin for Budd-Chiari syndrome with chronic inferior vena cava thrombosis：an initial clinical experience［J］.Ann Vasc Surg，2011，25（3）：359-365.doi：10.1016/j.avsg.2010.07.019http://dx.doi.org/10.1016/j.avsg.2010.07.019.

Wang R，Meng Q，Qu L，et al.Treatment of Budd-Chiari syndrome with inferior vena cava thrombosis［J］.Exp Ther Med，2013，5（4）：1254-1258.doi：10.3892/etm.2013.961http://dx.doi.org/10.3892/etm.2013.961.

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.doi：10.1016/j.jvir.2016.04.019http://dx.doi.org/10.1016/j.jvir.2016.04.019.

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（6）：1158-1164.doi：10.1016/j.ejrad.2011.03.021http://dx.doi.org/10.1016/j.ejrad.2011.03.021.

Ding PX，Li YD，Han XW，et al.Treatment of Budd-Chiari syndrome with urokinase following predilation in patients with old inferior vena cava thrombosis［J］.Radiol Med，2011，116（1）：56-60.doi：10.1007/s11547-010-0600-6http://dx.doi.org/10.1007/s11547-010-0600-6.

Yu C，Gao Y，Nie Z，et al.Effectiveness and postoperative prognosis of using pre-opening and staged percutaneous transluminal angioplasty of the inferior vena cava in treating Budd-Chiari syndrome accompanied with inferior vena cava thrombosis［J］.Ann Vasc Surg，2019，60：52-60.doi：10.1016/j.avsg.2019.03.037http://dx.doi.org/10.1016/j.avsg.2019.03.037.

Han XW，Ding PX，Li YD，et al.Retrieval stent filter：treatment of Budd Chiari syndrome complicated with inferior vena cava thrombosis--initial clinical experience［J］.Ann Thorac Surg，2007，83（2）：655-660.doi：10.1016/j.athoracsur.2006.06.084http://dx.doi.org/10.1016/j.athoracsur.2006.06.084.

Reza F，Naser DE，Hossein G，et al.Combination of thrombolytic therapy and angioplastic stent insertion in a patient with Budd-Chiari syndrome［J］.World J Gastroenterol，2007，13（27）：3767-3769.doi：10.3748/wjg.v13.i27.3767http://dx.doi.org/10.3748/wjg.v13.i27.3767.

Ludwig J，Hashimoto E，McGill DB，et al.Classification of hepatic venous outflow obstruction：ambiguous terminology of the Budd-Chiari syndrome［J］.Mayo Clin Proc，1990，65（1）：51-55.doi：10.1016/s0025-6196（12）62109-0http://dx.doi.org/10.1016/s0025-6196（12）62109-0.

Plessier A，Valla DC.Budd-Chiari syndrome［J］.Semin Liver Dis，2008，28（3）：259-269.doi：10.1055/s-0028-1085094http://dx.doi.org/10.1055/s-0028-1085094.

Mancuso A.Budd-Chiari syndrome in the West and the East：same syndrome，different diseases［J］.Liver Int，2019，39（12）：2417.doi：10.1111/liv.14131http://dx.doi.org/10.1111/liv.14131.

Xu K，Feng B，Zhong H，et al.Clinical application of interventional techniques in the treatment of Budd-Chiari syndrome［J］.Chin Med J （Engl），2003，116（4）：609-615.

Shukla A，Shreshtha A，Mukund A，et al.Budd-Chiari syndrome：consensus guidance of the Asian Pacific Association for the Study of the Liver （APASL）［J］.Hepatol Int，2021，15（3）：531-567.doi：10.1007/s12072-021-10189-4http://dx.doi.org/10.1007/s12072-021-10189-4.

Bilbao JI，Pueyo JC，Longo JM，et al.Interventional therapeutic techniques in Budd-Chiari syndrome［J］.Cardiovasc Intervent Radiol，1997，20（2）：112-119.doi：10.1007/s002709900117http://dx.doi.org/10.1007/s002709900117.

Fisher NC，McCafferty I，Dolapci M，et al.Managing Budd-Chiari syndrome：a retrospective review of percutaneous hepatic vein angioplasty and surgical shunting［J］.Gut，1999，44（4）：568-574.doi：10.1136/gut.44.4.568http://dx.doi.org/10.1136/gut.44.4.568.

Giannini M，Rollo HA，Maffei FH，et al.Advances in ultrasound techniques improve early detection of deep vein thrombosis［J］.Int Angiol，2008，27（6）：466-474.

孙欣，王金萍.彩色多普勒超声对Budd-Chiari综合征合并血栓的诊断价值［J］.实用医学影像杂志，2008，9（6）：392-394.doi：10.3969/j.issn.1009-6817.2008.06.018http://dx.doi.org/10.3969/j.issn.1009-6817.2008.06.018.

Virmani V，Khandelwal N，Kang M，et al.MDCT venography in the evaluation of inferior vena cava in Budd-Chiari syndrome［J］.Indian J Gastroenterol，2009，28（1）：17-23.doi：10.1007/s12664-009-0004-5http://dx.doi.org/10.1007/s12664-009-0004-5.

游箭，胡鸿，魏欣，等.布加氏综合征合并下腔静脉血栓形成的影像诊断和介入治疗［J］.当代医学，2010，16（35）：640-642.doi：10.3969/j.issn.1009-4393.2010.35.001http://dx.doi.org/10.3969/j.issn.1009-4393.2010.35.001.

Zhou P，Ren J，Han X，et al.Initial imaging analysis of Budd-Chiari syndrome in Henan province of China：most cases have combined inferior vena cava and hepatic veins involvement［J］.PLoS One，2014，9（1）：e85135.doi：10.1371/journal.pone.0085135http://dx.doi.org/10.1371/journal.pone.0085135.

徐浩，祖茂衡，顾玉明，等.Budd-Chiari综合征合并血栓形成的介入治疗［J］.中华放射学杂志，2001，35（1）：24-27.doi：10.3760/j.issn：1005-1201.2001.01.008http://dx.doi.org/10.3760/j.issn：1005-1201.2001.01.008.

Wang Q，Li K，He C，et al.Angioplasty with versus without routine stent placement for Budd-Chiari syndrome：a randomised controlled trial［J］.Lancet Gastroenterol Hepatol，2019，4（9）：686-697.doi：10.1016/S2468-1253（19）30177-3http://dx.doi.org/10.1016/S2468-1253（19）30177-3.

Kageyama K，Yamamoto A，Jogo A，et al.Usefulness of venous pressure measurement in endovascular treatment of Budd-Chiari syndrome：a retrospective cohort study［J］.Intern Med，2019，58（20）：2923-2929.doi：10.2169/internalmedicine.2704-19http://dx.doi.org/10.2169/internalmedicine.2704-19.

Wang Z，Wang Z，Zhang Z，et al.Establishment and validation of a prediction model for the first recurrence of Budd-Chiari syndrome after endovascular treatment：a large sample size，single-center retrospective study［J］.Hepatol Int，2023，17（1）：159-169.doi：10.1007/s12072-022-10464-yhttp://dx.doi.org/10.1007/s12072-022-10464-y.

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