目的 评估腔内对吻技术治疗下腔静脉慢性阻塞性疾病的可行性及应用价值.方法 回顾性分析浙江宁波第二医院血管外科2015年6月至2018年7月收治的9例下腔静脉阻塞性疾病患者的临床资料,其中2例为布加综合征(肝后段下腔静脉阻塞),7例为严重下肢深静脉血栓后综合征伴下腔静脉慢性阻塞(其中4例为下腔静脉滤器植入患者).患者均采用双侧腔内对吻球囊扩张技术,术中1例伴有新鲜静脉血栓形成,予以吸栓溶栓后再次植入支架.术后观察患者症状改善及并发症情况;出院后通过门诊复查形式,随访观察患者症状是否复发、支架是否通畅及是否存在支架移位.结果 本组9例患者中,2例行对吻球囊扩张,7例行对吻球囊联合对吻支架植入,共植入支架48枚.术后患者症状均明显改善,无严重并发症发生.患者随访时间1~18个月,症状无复发;影像学复查发现支架内血流通畅,无支架移位.结论 腔内对吻技术在下腔静脉慢性阻塞疾病中值得尝试,短期通畅率和预后满意,长期效果有待进一步的随访.
Objective To evaluate the feasibility and application value of kissing balloon technique in the treatment of chronic obstructive diseases of inferior vena cava. Methods From June 2015 to July 2018, a total of 9 patients with inferior vena cava obstructive disease in our department of vascular surgery, the Second of Ningbo Hospital, Zhejiang province, were retrospectively analyzed. 2 cases were Budd-Chiari syndrome (inferior vena cava obstruction), and 7 cases were severe deep venous thrombosis syndrome of lower limb with chronic obstruction of inferior vena cava (including 4 cases implanted with long-term inferior vena cava filters). All patients received bilateral kissing balloon dilatation. One patient was accompanied with fresh venous thrombosis, and thrombolysis was applied. After procedure, patient's symptoms and complications were monitored. During the follow-up, recurrence rate of symptoms, patency rate and misplacement of stent were monitored. Results Of the total 9 patients, 2 received kissing-balloon dilatation, and 7 received bilateral balloon combined with kissing-stent. A total of 48 stents were placed. The symptoms of the patients were significantly improved after surgery, and no severe complications occurred. Patients were followed up for 1~18 months after operation. In-stent stenosis, stent displacement and symptom recurrence were not observed during imaging reexamination. Conclusion The kissing balloon technique was worthy of trial in the chronic obstruction of the inferior vena cava. The short-term patency rate and prognosis were satisfactory, and the long-term effect need further follow-up.