上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

巴德-吉亚利综合征合并下腔静脉血栓形成的临床治疗疗效对比分析

胡丽萍1，王 晖1，余朝文2，高 涌2，吴华东2，程志俭1，高 斌1   

  1. 1.复旦大学附属上海市第五人民医院普外科， 上海 200240； 2.蚌埠医学院第一附属医院血管外科， 蚌埠 233000
  • 出版日期:2014-03-28 发布日期:2014-04-02
  • 作者简介:胡丽萍(1988—)， 女， 住院医师, 硕士; 电子信箱: hlpnewlife@yeah.net。

Comparative analysis of clinical efficacy of treatment to Budd-Chiari syndrome with inferior vena cava thrombosis

HU Li-ping1, WANG Hui1, YU Chao-wen2, GAO Yong2, WU Hua-dong2, CHENG Zhi-jian1, GAO Bin1   

  1. 1.Department of General Surgery, the Fifth People's Hospital of Shanghai, Fudan University, Shanghai 200240, China; 2.Department of Vascular Surgery，the First Affiliated Hospital Bengbu Medical College，Bengbu 233000，China
  • Online:2014-03-28 Published:2014-04-02

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摘要：

目的 对比分析巴德-吉亚利综合征合并下腔静脉血栓形成的临床治疗疗效。方法 回顾性分析68例膜性或短段闭塞性巴德-吉亚利综合征合并下腔静脉血栓形成患者的临床资料。根据下腔静脉血栓治疗方法将患者随机分为小球囊预开通治疗组（A组，n=21）、置管溶栓治疗组（B组，n=20）和保守治疗组（C组，n=27），每48 h 数字减影血管造影观察下腔静脉血栓溶解情况，血栓完全溶解后常规应用直径20～30 mm大球囊扩张狭窄或闭塞段管腔。结果 治疗2 d后，A组血栓溶解率（76.2%）显著高于B组（45.0%）和C组（18.5%）(均P＜0.05)，B组血栓溶解率显著高于C组(P＜0.05)；治疗4 d后，A组与B组血栓溶解率（85.7%和75.0%）比较差异无统计学意义(P＞0.05)，A组和B组血栓溶解率均显著高于C组（37.0%）(均P＜0.05)；治疗6 d后，A组和B组血栓溶解率（90.5%和90.0%）比较差异无统计学意义(P＞0.05)，A组和B组血栓溶解率均显著高于C组（51.9%）(均P＜0.05)。所有患者抗凝溶栓治疗6 d后无症状性肺栓塞、出血等严重并发症发生。结论 小球囊预开通及置管溶栓治疗巴德-吉亚利综合征合并下腔静脉血栓形成效果均较好，小球囊预开通治疗较置管溶栓治疗更安全迅速。

关键词: 巴德-吉亚利综合征, 下腔静脉, 血栓, 介入治疗

Abstract:

Objective To comparatively analyze the clinical efficacies of treatment to Budd-Chiari syndrome with inferior vena cava thrombosis. Methods Retrospective analysis of clinical data of 68 cases of membranous or short-segment occlusion Budd-Chiari syndrome with inferior vena cava thrombosis was performed. Depending on the treatment methods of inferior vena cava thrombosis, patients were randomly divided into three groups, i.e. predilation technique group (group A with 21 cases), catheter directed thrombolysis group (group B with 20 cases), and conservative treatment group (group C with 27cases). Digital subtraction angiography (DSA) observations of the inferior vena cava thrombolysis were conducted every 48 h. After thrombi were completely dissolved, conventional large balloons of 20-30 mm were used to inflate the lumen stenoses or occlusion segments. Results Two days after treatment, the thrombolytic rate of group A (76.2%) was significantly higher than that of group B (45.0%) and group C (18.5%)(P＜0.05), and the thrombolytic rate of group B was significantly higher than that of group C (P＜0.05). Four days after treatments, the difference of the thrombolytic rates of group A (85.7%) and group B (75.0%) was not statistically significant (P＞0.05), and the thrombolytic rates of group A and group B were significantly higher than that of group C (37.0%)(P＜0.05). Six days after treatments, the difference of the thrombolytic rates of group A (90.5%) and group B (90.0%) was not statistically significant (P＞0.05), and the thrombolytic rates of group A and group B were significantly higher than that of group C (51.9%)(P＜0.05). After six days, all patients with anticoagulant and thrombolytic therapy had no sign of symptomatic pulmonary embolism, bleeding, and other serious complications. Conclusion The clinical efficacies of predilation technique and catheter directed thrombolysis are all good for the treatment of Budd-Chiari syndrome with inferior vena cava thrombosis and the former is safer and quicker.

Key words: Budd-Chiari syndrome, inferior vena cava, thrombosis, interventional treatment