探讨不同类型肝静脉型布加综合征（BCS）的介入治疗临床疗效。

回顾性分析2014年1月至2024年12月徐州医科大学附属医院收治的189例肝静脉型BCS患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男89例，女100例；年龄20~79岁，中位年龄46岁。根据肝静脉病变类型分为膜性组65例、节段组53例、广泛阻塞组39例、血栓组32例。膜性组和节段组采用球囊扩张和（或）支架置入治疗；广泛阻塞组采用经颈静脉肝内门体静脉分流术（TIPS）治疗；血栓组清除血栓，然后行血管成形术或TIPS治疗。术后采用彩超、磁共振静脉成像（MRV）或CT静脉成像监测血管通畅情况。治疗前后静脉压力改变比较采用配对t检验，肝功能Child-Pugh分级比较采用χ² 检验。首次累积通畅率采用Kaplan-Meier法计算并用Log-rank检验比较。

所有患者介入治疗均成功，无严重并发症。介入治疗前后膜性组肝静脉-下腔静脉压差由（13.6±3.7） mmHg（1 mmHg=0.133 kPa）降至（4.1±1.6） mmHg，节段组由（11.7±2.3） mmHg降至（4.7±2.4） mmHg，血栓组由（14.2±3.1） mmHg降至（4.9±2.7） mmHg（t=15.649，16.537，17.341；P<0.05）；广泛阻塞组门静脉压力梯度（PPG）由（24.7±3.5） mmHg下降至（9.8±2.8） mmHg（t=18.036，P<0.05）。随访时间3.0~134.0个月，中位随访时间65.3个月，失访8例。膜性组62例中肝静脉通畅51例，再狭窄11例；支架置入患者再狭窄率高于单纯球囊扩张患者（χ²=9.605，P=0.002）。节段组51例中肝静脉通畅34例，再狭窄17例；支架置入患者再狭窄率明显高于单纯球囊扩张患者（χ²=6.951，P=0.008）。广泛阻塞组37例中TIPS分流道通畅21例，支架内再狭窄16例；术后肝性脑病3例，2例患者分别于术后17、68个月死于肝衰竭。血栓组26例行血管成形术患者中肝静脉再狭窄12例，5例TIPS患者中支架内再狭窄1例，1例于术后105个月死于与BCS无关的原因。术前肝功能Child-Pugh分级A级、B级、C级的患者分别为58、76、47例，术后3个月相应为98、68、15例，肝功能明显改善（χ²=27.217，P<0.001）。1、3、5、10年的首次累积通畅率膜性组分别为92.2%、83.5%、75.4%、61.8%，节段组为90.8%、81.1%、63.3%、51.4%，广泛阻塞组为91.6%、81.6%、72.7%、52.2%，血栓组为84.7%、78.9%、67.3%、55.1%，4组首次累积通畅率比较差异无统计学意义（χ²=1.094，P=0.778）。

肝静脉型BCS根据不同类型采取相应介入治疗方法可取得较好的中远期疗效：膜性阻塞单纯球囊扩张即可取得较好疗效；节段性阻塞以球囊扩张治疗为主，支架置入可作为补救性治疗措施，广泛阻塞首选TIPS治疗；血栓形成患者先清除血栓，根据情况行血管成形术或TIPS治疗。

To evaluate clinical efficacy of interventional therapy for patients with different types of hepatic vein-type Budd-Chiari syndrome (BCS).

Clinical data of 189 patients with hepatic vein-type BCS admitted to the Affiliated Hospital of Xuzhou Medical University from January 2014 to December 2024 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 89 patients were male and 100 female, aged from 20 to 79 years, with a median age of 46 years. According to different types of hepatic venous lesions, all patients were divided into the membranous obstruction group (n=65), segmental obstruction group (n=53), extensive obstruction group (n=39) and thrombus group (n=32). In the membranous and segmental obstruction groups, balloon dilatation and/or stent implantation were performed. In the extensive obstruction group, transjugular intrahepatic portosystemic shunt (TIPS) was adopted. In the thrombus group, thrombi were removed, followed by angioplasty or TIPS. Postoperative color Doppler ultrasound, magnetic resonance venography (MRV) or CT venography were used to monitor the patency of blood vessels. The changes of venous pressure before and after treatment were compared by paired t-test. Child-Pugh scores of liver function were compared by Chi-square test. The first cumulative patency rate was calculated by Kaplan-Meier method and compared with Log-rank test.

All patients were successfully treated by interventional therapy without severe complications. Before and after interventional therapy, the pressure difference between hepatic vein and inferior vena cava was decreased from (13.6±3.7) mmHg (1 mmHg=0.133 kPa) to (4.1±1.6) mmHg in the membranous obstruction group, from (11.7±2.3) mmHg to (4.7±2.4) mmHg in the segmental obstruction group , and from (14.2±3.1) mmHg to (4.9±2.7) mmHg in the thrombus group (t=15.649, 16.537, 17.341; all P<0.05). Portal pressure gradient (PPG) was decreased from (24.7±3.5) mmHg to (9.8±2.8) mmHg in the extensive obstruction group (t=18.036, P<0.05). The follow-up time was 3.0-134.0 months. The median follow-up time was 65.3 months. 8 cases were lost to follow-up. Among 62 patients in the membranous obstruction group, 51 cases achieved the patency of hepatic veins and 11 cases developed restenosis. The restenosis rate of patients undergoing stent implantation was significantly higher than that of those receiving balloon dilatation (χ²=9.605, P=0.002). Among 51 cases in the segmental obstruction group, 34 patients achieved the patency of hepatic veins and 17 cases had restenosis. The restenosis rate of patients with stent implantation was significantly higher than that of those receiving balloon dilatation (χ²=6.951, P=0.008). In the extensive obstruction group (n=37), 21 cases had vessel patency after TIPS and 16 cases had in-stent restenosis. 3 patients were diagnosed with hepatic encephalopathy after operation. 2 patients died of liver failure at postoperative 17 and 68 months,respectively. In the thrombus group, 12 of 26 patients undergoing angioplasty experienced hepatic venous restenosis, 1 of 5 cases receiving TIPS had in-stent restenosis, and 1 case died at postoperative 105 month, which was unrelated to BCS. According to preoperative Child-Pugh classification of liver function, 58, 76 and 47 patients were classified as Child-Pugh A, Child-Pugh B and Child-Pugh C, and 98, 68 and 15 cases of Child-Pugh A, Child-Pugh B and Child-Pugh C at postoperative 3 months, respectively. The liver function was significantly improved (χ²=27.217, P<0.001). The first cumulative patency rates at postoperative 1, 3, 5 and 10 years were 92.2%, 83.5%, 75.4% and 61.8% in the membranous obstruction group, 90.8%, 81.1%, 63.3% and 51.4% in the segmental obstruction group, 91.6%, 81.6%, 72.7% and 52.2% in the extensive occlusion group, and 84.7%, 78.9%, 67.3% and 55.1% in the thrombus group, respectively. No significant difference was observed in the first cumulative patency rate among four groups (χ²=1.094, P=0.778).

According to different types of hepatic vein-type BCS, corresponding interventional therapies can achieve favorable middle-and long-term efficacy. In the membranous obstruction group, balloon dilatation alone is recommended. Segmental obstruction is mainly treated by balloon dilatation, and stent implantation can be used as a remedial treatment. TIPS is recommended for extensive obstruction. For thrombosis patients, thrombi should be removed first, followed by angioplasty or TIPS according to individual conditions.