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目的:Budd-Chiari 综合征血流动力学较复杂,作者结合开展介入治疗本病的经验体会,提出新的分型及可供选择的治疗方法。材料、方法和结果:本组41例,对其中的28例做了介入治疗。确诊检查方法为 B 超、导管法腔静脉或/和肝静脉造影,经皮肝穿肝静脉造影。分型及介入治疗方法选择:Ⅰ型:单纯肝静脉阻塞以球囊扩张为主,如狭窄解除不满意可置入内支架。Ⅱ型:膜性或节段性不全阻塞,以球囊扩张为主,选择性置入内支架。Ⅲ型:膜性完全性阻塞,采用穿通术及球囊扩张。Ⅳ型:节段性完全性闭塞,采用穿通术,球囊扩张及内支架置入。Ⅴ型:伴有多发性下腔静脉膜性或节段性阻塞,以球囊扩张为主,选择性置入内支架。Ⅱ、Ⅲ、Ⅳ、Ⅴ型如合并肝静脉阻塞需开通肝静脉。如下腔静脉节段性闭塞合并肝静脉不通,而肝外侧支循环建立较好,可主要处理肝静脉,如侧支循环建立不好,肝静脉,下腔静脉均应处理。
OBJECTIVE: The hemodynamics of Budd-Chiari syndrome is rather complicated. The author combined experience of interventional therapy for this disease and proposed new classification and treatment options. Materials, Methods and Results: The group of 41 cases, of which 28 cases were interventional treatment. Diagnostic methods for the B ultrasound, catheter or vena cava and / and hepatic venography, percutaneous transhepatic hepatic venography. Type and interventional treatment options: Type Ⅰ: simple hepatic vein occlusion to balloon dilatation, such as the stenosis can not be satisfied with the placement of the stent. Type Ⅱ: membranous or segmental obstruction, mainly to balloon dilatation, selective placement of the stent. Ⅲ type: complete membranous obstruction, the use of perforation and balloon dilatation. Type Ⅳ: segmental complete occlusion, the use of perforation, balloon dilatation and stent placement. Ⅴ type: with multiple inferior vena cava membranous or segmental obstruction to the main balloon dilatation, selective placement of the stent. Ⅱ, Ⅲ, Ⅳ, Ⅴ type such as hepatic vein occlusion need to open the hepatic vein. The following vena cava segmental occlusion with hepatic vein barrier, and the extrahepatic collateral circulation established better, the main treatment of the hepatic vein, such as collateral circulation to establish a poor, hepatic vein, inferior vena cava should be treated.