復(fù)雜類型布加綜合征的介入治療

復(fù)雜類型布-加綜合征的介入治療InterventionalTherapyofcomplexBudd-ChiariSyndromeInterventionalRadiologyDepartmentofWuhanUnionHospitalInterventionalRadiologyDepartmentofWuhanUnionHospitalPart1：overviewGeneraldefinitionClassificationPathologicalchangeClinicalmanifestationTherapy

.inverventionaltherapyisthefirstchoice.InterventionalRadiologyDepartmentofWuhanUnionHospitalPart2：complexBCSIVC.biningwiththrombosisHV.segementocclusion.widespreadocclusionOcclusionofHV&IVCInterventionalRadiologyDepartmentofWuhanUnionHospitalPart3：therapy&casesreportInterventionalRadiologyDepartmentofWuhanUnionHospitalIVC：longsegementocclusionAnatomyofIVC：pre-operationAngiography：two-way&multipledirectionsPuncture：resistingforce&directionsTrackofguidewireDilatationEndovascularstentInterventionalRadiologyDepartmentofWuhanUnionHospitalFigure1.(a,b)A-PandLPangiographyshowtheocclusionsegmentlengthis8.2cm.(c,d)UsingTIPSpunctureneedlereconstrcutedtheocclusionsegment.abcdInterventionalRadiologyDepartmentofWuhanUnionHospitalFigure1.Thesamepatient.UsingballoondilatedtheocclusionsegmentandreleaseZ-shapeESinIVC(e～h).efghInterventionalRadiologyDepartmentofWuhanUnionHospital

IVC：occlusion&thrombosisD.D.ofthrombus:per-operationFreshthrombus：thrombolysis&suction&/.micro-caliberpunctureOrganizedthrombus：mini-caliberpuncture&ES&dilatationThrombolysis&anticoagulation:postoperationInterventionalRadiologyDepartmentofWuhanUnionHospitalFigure2.AngiographyofIVCshowsthegiantfillingdefectinIVC(a)andcontrastmediumcontaminatedthethrombus(b).UsingUKinjectionfromthecathetertwodayslater,thereisnosignofthrombus(c)andpuncturetheocclusionsegmentsuccessfully（d）.abcdInterventionalRadiologyDepartmentofWuhanUnionHospitalFigure3.TheimagesofMRIshowthelongsegmentorganizationthrombusinIVC(b,arrowhead).abInterventionalRadiologyDepartmentofWuhanUnionHospitalFigure4.(a,b)AngiographyshowslongsegmentocclusionandtheirregularfillingdefectinIVC,whichreachsthelevelofleftrenalveinoutlet(arrowhead).Puncturetheocclusionanddilateditwithballoon(c,d).abcdInterventionalRadiologyDepartmentofWuhanUnionHospitalefghFigure4.(e,f)UsingabiggerballoondilatedtheocclusionsegmentandreleaseZ-shapeEStofixthethrombusonthewallofIVC.InterventionalRadiologyDepartmentofWuhanUnionHospitalHV：segementocclusionClinicalmanifestation：aggravated、serious、ascits、liverfunctionfailureimagecharacteristicTherapia：

.PunctureHVfromIVCorHV.PercutaneouspunctureHV.EndovascularstentInterventionalRadiologyDepartmentofWuhanUnionHospitalaFigure5.(a)TheangiographyfromIVC.(b)TheangiographyafterpercutaneouspuncturetheocclusionHV.(c)Angiographythroughcatheterafterballoondilatation.(d)ReleaseES.bcdInterventionalRadiologyDepartmentofWuhanUnionHospitalFigure6.PercutaneouspuncturetheocclusionHVunderUSguiding.(a)diagram.(b)inoperation.

abInterventionalRadiologyDepartmentofWuhanUnionHospitalFigure7.(a)AngiographyformIVC.(b)percutaneouspuncturetheocclusionHVunderUSguiding.(c,d)guidewiretrackandballoondilatation.(e,f)withoutocclusionsignsafteroperation.abcdefInterventionalRadiologyDepartmentofWuhanUnionHospitalHV：largeamountascitsClinicalmanifestation:seriousRisksofoperation：bleeding、infection…Therapia

.PunctureHVfromIVC.AngiographyofHV.EndovascularstentInterventionalRadiologyDepartmentofWuhanUnionHospitalFigure8.(a)FineneedlepunctureHVandangiographyforguiding.(b～d)trytopuncturetheocclusionHVcannotsucceedfromjugularway.(e,f)femoralwaysucceed.abcdefInterventionalRadiologyDepartmentofWuhanUnionHospitalFigure9.Thesamepatient.(a,b)lagreamountascitsbeforeoperation(T2WIimgeofMRI).(c)frogbelly(peroperative).(d)ascitsdismissed(post-operative).abcdInterventionalRadiologyDepartmentofWuhanUnionHospitalHV：widespreadocclusionTherapy：transjuguarintrahepaticportosystemicstentshunt,TIPSSTheoreticaldisputableReconstruction,notrecanalization**XuPQ,MaXX,Yexx,etal.SurgialTreatmentof1360casesofBudd-ChiariSyndrome:20-yearExperience.HepatobiliaryPancreatDisint,2004,3(3):391-394.InterventionalRadiologyDepartmentofWuhanUnionHospitalFigure10.(a)PercutaneouspuncturePVforguiding.(b,d)ReconstructiontheshuntbetweenPVandHV.(e,f)Angiographyafteroperation.abcdefInterventionalRadiologyDepartmentofWuhanUnionHospitalFigure11.

(a)DirectlypunctureintoIVCfromrPV.(b～d)ReconstructiontheshuntbetweenPVandHV.(e)SchematicdiagramofdirectlypunctureIVC.abcdeInterventionalRadiologyDepartmentofWuhanUnionHospitalOcclusionofHV&IVCThreetunnelsRecanalizedIVCfirstlyES:.UseZ-shapestentinIVC.ReleaseESinporperorder：IVCfirstlyorHVfirstlyInterventionalRadiologyDepartmentofWuhanUnionHospitalFigure12.（a～c）IVCwasrecanalizedfirstly.(d,e)PuncturetheocclusionHVsecondly.(f)Theangiographyafteroperation.abcdefInterventionalRadiologyDepartmentofWuhanUnionHospitalconclusionPerop