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目的评价下腔静脉(IVC)型布加综合征(BCS)合并IVC陈旧性血栓形成的治疗方法、疗效及预后。方法回顾性分析2004年4月至2014年4月因膜性或短段闭塞性IVC型BCS合并IVC陈旧性血栓形成于本院行介入治疗的119例患者的临床资料,比较行小球囊预开通治疗及可回收支架治疗患者的疗效差异。结果 119例患者中,56例接受小球囊预开通治疗(预开通组),63例接受可回收支架治疗(可回收支架组)。除可回收支架组有1例患者术中发生支架断裂、经外科手术外,其余118例患者介入手术均成功。术后两组患者均取得满意疗效,预开通组与可回收支架组两组间尿激酶用量、溶栓时间、住院时间及并发症发生率比较,差异均无统计学意义(P>0.001),预开通组花费更低(P<0.001)。术后119例患者均获随访,随访时间为18~66个月,平均44.2个月。随访期间,预开通组及可回收支架组分别有6例患者发生原闭塞处的再次狭窄闭塞,预开通组与可回收支架组复发率无明显差异(P=0.23)。复发患者经再次扩张治疗后未再发生管腔狭窄和血栓形成。结论小球囊预开通技术及可回收支架技术治疗IVC型BCS合并IVC内陈旧性血栓的效果满意,且前者更经济安全。
Objective To evaluate the treatment, curative effect and prognosis of IVC-type Budd-Chiari syndrome (BCS) complicated with IVC old thrombosis. Methods The clinical data of 119 patients with membranous or short-segment occlusive IVC BCS combined with IVC old thrombosis in our hospital from April 2004 to April 2014 were retrospectively analyzed. Differences in the efficacy of open treatment and recoverable stent treatment. Results Of the 119 patients, 56 received precontracted small balloon preoperation and 63 received retractable stents. One of the patients except the recoverable stent group had a stent fracture during operation, and the remaining 118 patients were successfully surgically treated by surgery. The postoperative patients in both groups achieved satisfactory curative effect. There was no significant difference in the dosage of urokinase, thrombolysis time, length of hospital stay and complication between the preopened group and the recoverable stent group (P> 0.001) The pre-open group cost less (P <0.001). All 119 patients were followed up for 18-66 months (average 44.2 months). During the follow-up period, there were 6 cases of recanalization occlusion in the preopened group and the recoverable stent group, respectively. There was no significant difference (P = 0.23) between the preopened group and the recoverable stent group. No recurrence of stenosis and thrombosis occurred in patients who relapsed after reexpansion. Conclusions The preopening of small balloon and the technique of recoverable stent are satisfactory for the treatment of old thrombus in IVC combined with IVC and the former is more economical and safe.