摘要
目的探讨下腔静脉造影检查在布加综合征(BCS)患者下腔静脉阻塞亚型与下腔静脉阻塞端钙化相关性研究中的应用价值。方法采用回顾性横断面研究方法。收集2009年1月至2016年12月徐州医科大学附属医院收治的41例BCS患者的临床资料;男29例,女12例;年龄为(53±10)岁,年龄范围为34~70岁。41例BCS患者均行CT平扫及下腔静脉CT造影检查,并于2周内行数字减影血管造影(DSA)检查。经DSA检查确定下腔静脉阻塞端形态后,根据钙化灶形态和位置,行球囊扩张术和(或)下腔静脉血管内支架植入术。观察指标:(1)下腔静脉阻塞端钙化情况。(2)介入治疗术中情况。(3)下腔静脉阻塞亚型与下腔静脉阻塞端钙化的相关性。(4)随访和生存情况。采用门诊方式进行随访,术后3、6、12、24、36、48个月常规行下腔静脉超声检查,了解患者术后临床症状和体征、并发症发生情况和生存情况。随访时间截至2018年12月。正态分布的计量资料以Mean±SD表示。计数资料以绝对数表示,组间比较采用χ^2检验。采用似然比检验分析下腔静脉阻塞亚型与下腔静脉阻塞端钙化之间的相关性。采用Cramer′s修正列联系数V分析两者间的相关程度。结果(1)下腔静脉阻塞端钙化情况:41例患者中,17例未检测到下腔静脉阻塞端钙化,24例检测到下腔静脉阻塞端钙化。24例患者钙化位置:17例为下腔静脉阻塞远端钙化,4例为下腔静脉阻塞近端钙化,3例为下腔静脉阻塞远端及近端均钙化;钙化灶形态:20例呈点状,4例呈不规则状;钙化分布:20例为散在分布,3例为簇状分布,1例为弥漫性分布。(2)介入治疗术中情况:41例患者中,21例行球囊扩张术,20例行球囊扩张术联合血管内支架植入术。2例患者在行经皮穿刺术时出现右股静脉穿刺点血肿,立即给予加压包扎治疗。1例患者因下腔静脉阻塞端弥漫性钙化在术中发生球囊破裂,连续更换3枚球囊治疗后,下腔静脉狭窄程度改善。1例患者在行球囊扩张术时因梗阻远端血栓脱落引起肺栓塞,立即给予抗凝及大剂量尿激酶溶栓治疗。其余37例患者顺利完成介入治疗,术中未发生特殊情况。(3)下腔静脉阻塞亚型与下腔静脉阻塞端钙化之间的相关性:24例检测到下腔静脉阻塞端钙化的患者中,13例为膜性阻塞,7例为节段性阻塞,4例为膜性带孔阻塞;17例无下腔静脉阻塞端钙化的患者中,3例为膜性阻塞,13例为节段性阻塞,1例为膜性带孔阻塞。似然比检验结果显示:下腔静脉阻塞亚型与下腔静脉阻塞端钙化存在相关性(χ^2=9.293,P<0.05)。Cramer′s修正列联系数V=0.466。进一步分析结果显示:下腔静脉膜性阻塞与下腔静脉阻塞端钙化存在相关性(χ^2=8.121,P<0.05),而节段性阻塞和膜性带孔阻塞与下腔静脉阻塞端钙化不存在相关性(χ^2=3.395,0.004,P>0.05)。(4)随访及生存情况:41例患者均获得随访,随访时间为24.0~48.0个月,中位随访时间为37.1个月。38例患者术后超声检查显示下腔静脉回流顺利,下肢肿胀和静脉曲张等临床症状和体征均有不同程度的改善。3例患者下腔静脉阻塞端血栓仍存在,其中1例血栓明显减少(血流影响小),予以随访复查;2例患者出现术后再狭窄,行血管内支架植入术。41例患者均生存。结论BCS患者下腔静脉阻塞亚型与下腔静脉阻塞端钙化存在相关性。采用下腔静脉造影检查评估BCS患者下腔静脉阻塞端钙化情况对术前下腔静脉阻塞亚型的诊断及术中介入引导具有重要意义。
Objective To investigate the application value of inferior vena cava venography in correlation between the subtypes of inferior vena cava obstruction and calcifications at the obstruction in Budd-Chiari syndrome(BCS).MethodsThe retrospective cross-sectional study was conducted.The clinical data of 41 patients with BCS who were admitted to the Affiliated Hospital of Xuzhou Medical University between January 2009 and December 2016 were collected.There were 29 males and 12 females,aged(53±10)years,with a range of 34-70 years.Forty-one BCS patients underwent computed tomography(CT),inferior vena cava CT venography and digital subtraction angiography(DSA)within 2 weeks.Balloon dilatation and(or)endovascular stent implantation of inferior vena cava were performed according to calcification morphology and location of the inferior vena cava obstruction detected by DSA.Observation indicators:(1)calcifications of inferior vena cava obstruction;(2)intraoperative situations of interventional therapy;(3)correlation between the subtypes of inferior vena cava obstruction and calcifications at the obstruction;(4)follow-up and survival situations.Follow-up using outpatient examination of inferior vena cava venography was performed at 3,6,12,24,36,48 months postoperatively to detect postoperative clinical manifestations,complications and survival situations up to December 2018.Measurement data with normal distribution were represented as Mean±SD.Count data were represented as absolute number and comparison between groups was analyzed using the chi-square test.The likelihood ratio test was used to analyze the correlation between the subtypes of inferior vena cava obstruction and calcifications at the obstruction.The degree of correlation was detected by Cramer′s V contingency coefficient.Results(1)Calcifications of inferior vena cava obstruction:of 41 patients,17 had no calcification at the inferior vena cava obstruction and 24 had calcifications at the obstruction.Calcification location in 24 patients:there were 17,4 and 3 patients with proximal,distal,both proximal and distal calcifications at the inferior vena cava obstruction,respectively.Calcification morphology:punctate and irregular calcifications were detected in 20 and 4 patients,respectively.Calcification distribution:20,3 and 1 patients had scattered,cluster and diffuse distribution,respectively.(2)Intraoperative situations of interventional therapy:of 41 patients,21 underwent balloon dilatation and 20 underwent balloon dilatation combined with endovascular stent implantation.Two patients were detected hematoma at the puncture site of right femoral vein and treated using pressure dressing.One patient encountered rupture of balloon due to diffuse calcifications at the inferior vena cava obstruction and was improved after continual replace of balloon for 3 times.One patient had pulmonary embolism caused by detachment of the thrombosis at the distal obstruction during the balloon dilatation and was given anticoagulation therapy combined with thrombolytic therapy using large-dose of urokinase.The other 37 patients underwent successful interventional therapy without exceptional circumstances.(3)Correlation between the subtypes of inferior vena cava obstruction and calcifications at the obstruction:of 24 patients with calcifications at the inferior vena cava obstruction,13 had membrane obstruction,7 had segmental obstruction and 4 had fenestrated membrane obstruction.Of 17 patients without calcifications at the inferior vena cava obstruction,3 had membrane obstruction,13 had segmental obstruction and 1 had fenestrated membrane obstruction.The likelihood ratio test showed that the subtypes of inferior vena cava obstruction were associated with calcifications at the obstruction(χ^2=9.293,P<0.05),with the correlation coefficient V as 0.466.Further analysis showed a correlation between membrane obstruction of inferior vena cava and calcifications at the inferior vena cava obstruction(χ^2=8.121,P<0.05),no correlation between segmental obstruction and calcifications at the inferior vena cava obstruction,also no correlation between fenestrated membrane obstruction and calcifications at the inferior vena cava obstruction(χ^2=3.395,0.004,P>0.05).(4)Follow-up and survival situations:41 patients were followed up for 24.0-48.0 months,with a median time of 37.1 months.Postoperative ultrasound showed smooth backflow in the inferior vena cava,different degree of improvements in the lower limb swelling and varicosity in 38 patients.Embolisms in the inferior vena cava obstruction remained existent in 3 patients,1 of whom showed significant decreasing of embolisms.There were 2 patients found restenosis and undergoing endovascular stent implantation.All the 41 patients survived.ConclusionsThe subtypes of inferior vena cava obstruction are associated with calcifications at the obstruction in BCS.Inferior vena cava venography evaluating calcifications at the inferior vena cava obstruction in BCS can be helpful for diagnosing the subtypes of inferior vena cava obstruction and guiding its interventional therapy.
作者
徐慧婷
倪建明
张庆桥
夏风飞
徐凯
Xu Huiting;Ni Jianming;Zhang Qingqiao;Xia Fengfei;Xu Kai(Department of Radiology,the Affiliated Wuxi No.2 People's Hospital of Nanjing Medical Unirersity,Wuxi 214002,China;Department of Interuentional Radiology,the Ailiated Hospital of Xuzhou Medical University,Xuzhou 221002,China;Department of Radiology,the Afiliated Hospital of Xuchou Medical University,Xushou 221002,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2019年第4期394-399,共6页
Chinese Journal of Digestive Surgery
基金
"医学影像学"科教强卫创新团队(CXTDA2017028)
江苏省重点研发计划面上项目(BE2017637).
关键词
布加综合征
下腔静脉
钙化
体层摄影术
X线计算机
数字减影血管造影术
Budd-Chiari syndrome
Inferior vena cava
Calcification
Computed tomography,X-ray
Digital subtraction angiography
作者简介
通信作者:徐凯,Email:xkpaper@163.com.
