肝静脉阻塞型布加综合征的研究进展

郭旭; 吴浩

doi:10.12449/JCH240102

肝静脉阻塞型布加综合征的研究进展

DOI: 10.12449/JCH240102

郭旭,
吴浩^, ,

四川大学华西医院消化内科，成都 610041

基金项目:

国家自然科学基金 (82270649);

四川省科技厅重点研发项目 (22ZDYF0621);

四川大学华西医院临床研究孵化重点项目 (2019HXFH024)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：郭旭负责查阅文献、撰写论文；吴浩负责拟定文章写作方向与思路、指导论文撰写、修改与定稿。

详细信息

通信作者:
吴浩， hxxhwh@163.com （ORCID： 0000-0001-6751-3036）

计量
- 文章访问数: 268
- HTML全文浏览量: 77
- PDF下载量: 92
- 被引次数: 0
出版历程
- 收稿日期: 2023-10-31
- 录用日期: 2023-11-21
- 出版日期: 2024-01-23

Research advances in the diagnosis and treatment of hepatic vein occlusion-type Budd-Chiari syndrome

Xu GUO,
Hao WU^{,
,}

Department of Gastroenterology，West China Hospital，Sichuan University，Chengdu 610041，China

Research funding:

National Natural Science Foundation of China (82270649);

Sichuan Science and Technology Program (22ZDYF0621);

Clinical Research Incubation Project, West China Hospital, Sichuan University (2019HXFH024)

More Information

Corresponding author: WU Hao， hxxhwh@163.com （ORCID： 0000-0001-6751-3036）

摘要

摘要: 布加综合征作为一种罕见的肝血管疾病，根据肝脏流出道阻塞部位不同可分为肝静脉阻塞型、下腔静脉阻塞型和混合型。本文将着重于肝静脉阻塞型，对其流行病学、亚型分型、临床诊断、治疗策略等方面进行论述。
- Budd-Chiari综合征 /
- 诊断 /
- 治疗学
Abstract: Budd-Chiari syndrome is a rare liver vascular disease and can be classified into hepatic vein occlusion type， inferior vena cava occlusion type， and mixed type according to the location of hepatic outflow tract obstruction. This article reviews the hepatic vein occlusion type from the aspects of epidemiology， subtypes， clinical diagnosis， and treatment strategies.
- Budd-Chiari Syndrome /
- Diagnosis /
- Therapeutics

HTML全文

图 1 肝静脉阻塞型BCS治疗策略

注： TIPS，经颈静脉肝内门体分流术；DIPS，直接肝内门体分流术。

Figure 1. Treatment strategy for hepatic vein occlusion type BCS

下载: 全尺寸图片幻灯片

表 1 肝静脉阻塞型BCS亚型超声成像特点

Table 1. Ultrasound imaging characteristics of subtypes of hepatic vein occlusion type BCS

亚型分型	超声特点
肝静脉/副肝静脉膜性阻塞	肝静脉和副肝静脉开口处条带样高回声，血流受阻，膜下方肝静脉管腔扩张
肝静脉节段性阻塞	肝静脉近心段无血流
肝静脉广泛性阻塞	肝静脉主干成条索状回声，血流信号消失
肝静脉阻塞伴血栓形成	阻塞的肝静脉管腔内血栓回声，无血流回声

下载: 导出CSV

参考文献(49)

[1]	SHUKLA A, SHRESHTHA A, MUKUND A, et al. Budd-Chiari syndrome: Consensus guidance of the Asian Pacific Association for the study of the liver(APASL)[J]. Hepatol Int, 2021, 15( 3): 531- 567. DOI: 10.1007/s12072-021-10189-4.
[2]	HITAWALA AA, GUPTA V. Budd-Chiari syndrome[M]. Treasure Island(FL): StatPearls Publishing, 2023.
[3]	Expert committee on Vane Cava Obstruction, Specialized Committee of Endovascology, Chinese Medical Doctor Association. Expert consensus on the classification of subtype in Budd-Chiari syndrome[J]. J Clin Hepatol, 2017, 33( 7): 1229- 1235. DOI: 10.3969/j.issn.1001-5256.2017.07.005. 中国医师协会腔内血管学专业委员会腔静脉阻塞专家委员会. 布-加综合征亚型分型的专家共识[J]. 临床肝胆病杂志, 2017, 33( 7): 1229- 1235. DOI: 10.3969/j.issn.1001-5256.2017.07.005.
[4]	LI YY, de STEFANO V, LI HY, et al. Epidemiology of Budd-Chiari syndrome: A systematic review and meta-analysis[J]. Clin Res Hepatol Gastroenterol, 2019, 43( 4): 468- 474. DOI: 10.1016/j.clinre.2018.10.014.
[5]	ZHANG W, QI X, ZHANG XT, et al. Budd-chiari syndrome in China: A systematic analysis of epidemiological features based on the Chinese literature survey[J]. Gastroenterol Res Pract, 2015, 2015: 738548. DOI: 10.1155/2015/738548.
[6]	SHARMA A, KESHAVA SN, EAPEN A, et al. An update on the management of budd-chiari syndrome[J]. Dig Dis Sci, 2021, 66( 6): 1780- 1790. DOI: 10.1007/s10620-020-06485-y.
[7]	QI XS, de STEFANO V, SU CP, et al. Associations of antiphospholipid antibodies with splanchnic vein thrombosis[J]. Medicine, 2015, 94( 4): e496. DOI: 10.1097/md.0000000000000496.
[8]	ZHANG WG, DING PX, HAN XW, et al. Distribution of 1 259 patients with Budd Chiari-syndrome in Henan province[J]. Chin J Gastroenterol Hepatol, 2011, 20( 5): 472- 474. DOI: 10.3969/j.issn.1006-5709.2011.05.025. 张文广, 丁鹏绪, 韩新巍, 等. 1 259例河南省Budd-Chiari综合征分布分析[J]. 胃肠病学和肝病学杂志, 2011, 20( 5): 472- 474. DOI: 10.3969/j.issn.1006-5709.2011.05.025.
[9]	Expert Committee on Vena Cava Obstruction, Specialized Committee of Endovascology, Chinese Medical Doctor Association. Expert consensus on the definition of“membranous obstruction” and“segmental obstruction” of the inferior vena cava and hepatic vein in Budd-Chiari syndrome[J]. J Interv Radiol, 2016, 25( 7): 559- 561. DOI: 10.3969/j.issn.1008-794X.2016.07.001. 中国医师协会腔内血管学专业委员会腔静脉阻塞专家委员. 下腔静脉与肝静脉“膜”与“节段”阻塞界定的专家共识[J]. 介入放射学杂志, 2016, 25( 7): 559- 561. DOI: 10.3969/j.issn.1008-794X.2016.07.001.
[10]	WANG L, ZU MH, GU YM, et al. Budd-Chiari syndrome in children and adolescents: Therapeutic radiological intervention[J]. Chin J Pediatr, 2013, 51( 8): 590- 594. DOI: 10.3760/cma.j.issn.0578-1310.2013.08.007. 王磊, 祖茂衡, 顾玉明, 等. 儿童及青少年布加综合征的介入治疗[J]. 中华儿科杂志, 2013, 51( 8): 590- 594. DOI: 10.3760/cma.j.issn.0578-1310.2013.08.007.
[11]	MURAD SD, PLESSIER A, HERNANDEZ-GUERRA M, et al. Etiology, management, and outcome of the Budd-Chiari syndrome[J]. Ann Intern Med, 2009, 151( 3): 167- 175. DOI: 10.7326/0003-4819-151-3-200908040-00004.
[12]	ZHOU C, SHEN B, QU Y, et al. Current status of the clinical management of Budd-Chiari syndrome[J]. J Clin Hepatol, 2022, 38( 7): 1474- 1476. DOI: 10.3969/j.issn.1001-5256.2022.07.005. 周璀, 沈波, 曲颖, 等. 布加综合征的临床管理现状[J]. 临床肝胆病杂志, 2022, 38( 7): 1474- 1476. DOI: 10.3969/j.issn.1001-5256.2022.07.005.
[13]	PAREKH J, MATEI VM, CANAS-COTO A, et al. Budd-chiari syndrome causing acute liver failure: A multicenter case series[J]. Liver Transpl, 2017, 23( 2): 135- 142. DOI: 10.1002/lt.24643.
[14]	van WETTERE M, BRUNO O, RAUTOU PE, et al. Diagnosis of budd-chiari syndrome[J]. Abdom Radiol N Y, 2018, 43( 8): 1896- 1907. DOI: 10.1007/s00261-017-1447-2.
[15]	FARAOUN SA, BOUDJELLA ME, DEBZI N, et al. Budd-Chiari syndrome: An update on imaging features[J]. Clin Imaging, 2016, 40( 4): 637- 646. DOI: 10.1016/j.clinimag.2016.01.006.
[16]	HOFFMANN T, VOIGTLÄNDER H, FRÖHLICH E, et al. Single-center study: Evaluation of sonography in Budd-Chiari syndrome[J]. Z Gastroenterol, 2022, 60( 7): 1111- 1117. DOI: 10.1055/a-1550-3141.
[17]	BANSAL V, GUPTA P, SINHA S, et al. Budd-Chiari syndrome: Imaging review[J]. Br J Radiol, 2018, 91( 1092): 20180441. DOI: 10.1259/bjr.20180441.
[18]	DAS CJ, SONEJA M, TAYAL S, et al. Role of radiological imaging and interventions in management of Budd-Chiari syndrome[J]. Clin Radiol, 2018, 73( 7): 610- 624. DOI: 10.1016/j.crad.2018.02.003.
[19]	LIU SY, XIAO P, CAO HC, et al. Accuracy of computed tomographic angiography in the diagnosis of patients with inferior vena cava partial obstruction in Budd-Chiari syndrome[J]. J Gastroenterol Hepatol, 2016, 31( 12): 1933- 1939. DOI: 10.1111/jgh.13420.
[20]	VOGELZANG RL, ANSCHUETZ SL, GORE RM. Budd-chiari syndrome: CT observations[J]. Radiology, 1987, 163( 2): 329- 333. DOI: 10.1148/radiology.163.2.3562813.
[21]	PATIL P, DESHMUKH H, POPAT B, et al. Spectrum of imaging in Budd Chiari syndrome[J]. J Med Imaging Radiat Oncol, 2012, 56( 1): 75- 83. DOI: 10.1111/j.1754-9485.2012.02341.x.
[22]	CRUITE I, TANG A, MAMIDIPALLI A, et al. Liver imaging reporting and data system: Review of major imaging features[J]. Semin Roentgenol, 2016, 51( 4): 292- 300. DOI: 10.1053/j.ro.2016.05.003.
[23]	GUPTA P, BANSAL V, KUMAR-M P, et al. Diagnostic accuracy of Doppler ultrasound, CT and MRI in Budd Chiari syndrome: Systematic review and meta-analysis[J]. Br J Radiol, 2020, 93( 1109): 20190847. DOI: 10.1259/bjr.20190847.
[24]	MAMONE G, CAROLLO V, di PIAZZA A, et al. Budd-Chiari Syndrome and hepatic regenerative nodules: Magnetic resonance findings with emphasis of hepatobiliary phase[J]. Eur J Radiol, 2019, 117: 15- 25. DOI: 10.1016/j.ejrad.2019.05.015.
[25]	KHATRI G, MERRICK L, MILLER FH. MR imaging of hepatocellular carcinoma[J]. Magn Reson Imag Clin N Am, 2010, 18( 3): 421- 450. DOI: 10.1016/j.mric.2010.08.002.
[26]	BAHAR K, KARAYALÇIN S, KAYA M, et al. Percutaneous transhepatic venoplasty: An alternative treatment for Budd-Chiari syndrome[J]. Turk J Gastroenterol, 2002, 13( 2): 83- 88.
[27]	HERNÁNDEZ-GEA V, de GOTTARDI A, LEEBEEK FWG, et al. Current knowledge in pathophysiology and management of Budd-Chiari syndrome and non-cirrhotic non-tumoral splanchnic vein thrombosis[J]. J Hepatol, 2019, 71( 1): 175- 199. DOI: 10.1016/j.jhep.2019.02.015.
[28]	European Association for the Study of the Liver Electronic. EASL Clinical Practice Guidelines: Vascular diseases of the liver[J]. J Hepatol, 2016, 64( 1): 179- 202. DOI: 10.1016/j.jhep.2015.07.040.
[29]	SEIJO S, PLESSIER A, HOEKSTRA J, et al. Good long-term outcome of Budd-Chiari syndrome with a step-wise management[J]. Hepatology, 2013, 57( 5): 1962- 1968. DOI: 10.1002/hep.26306.
[30]	DENG YT, ZHOU JY. Budd-Chiari syndrome: Current state of the art[J]. J Pract Hepatol, 2023, 26( 2): 156- 159. DOI: 10.3969/j.issn.1672-5069.2023.02.002. 邓玉婷, 周俊英. 布加综合征诊治研究进展[J]. 实用肝脏病杂志, 2023, 26( 2): 156- 159. DOI: 10.3969/j.issn.1672-5069.2023.02.002.
[31]	LIU B, LI G. Progress in endoscopic and interventional treatment of esophagogastric variceal bleeding[J]. Dis Markers, 2022, 2022: 2940578. DOI: 10.1155/2022/2940578.
[32]	DHIMAN RK, SARASWAT VA, VALLA DC, et al. Portal cavernoma cholangiopathy: Consensus statement of a working party of the Indian national association for study of the liver[J]. J Clin Exp Hepatol, 2014, 4( Suppl 1): S2- S14. DOI: 10.1016/j.jceh.2014.02.003.
[33]	ZAMAN S, WIEBE S, BERNAL W, et al. Increased prevalence of heparin-induced thrombocytopenia in patients with Budd-Chiari syndrome: A retrospective analysis[J]. Eur J Gastroenterol Hepatol, 2016, 28( 8): 967- 971. DOI: 10.1097/MEG.0000000000000632.
[34]	SIMONETTO DA, SINGAL AK, GARCIA-TSAO G, et al. ACG clinical guideline: Disorders of the hepatic and mesenteric circulation[J]. Am J Gastroenterol, 2020, 115( 1): 18- 40. DOI: 10.14309/ajg.0000000000000486.
[35]	LI Z, WANG L, YI FF, et al. Rapid development of gingival bleeding after rivaroxaban in a patient with Budd-Chiari syndrome[J]. Liver Int, 2021, 41( 9): 2236- 2237. DOI: 10.1111/liv.15021.
[36]	ZHANG F, WANG CC, LI YW. The outcomes of interventional treatment for Budd-Chiari syndrome: Systematic review and meta-analysis[J]. Abdom Imaging, 2015, 40( 3): 601- 608. DOI: 10.1007/s00261-014-0240-8.
[37]	LI DM, YIN XE, YANG F, et al. Accessory hepatic vein recanalization for hepatic vein-type Budd-Chiari syndrome[J]. Minim Invasive Ther Allied Technol, 2021, 30( 4): 239- 244. DOI: 10.1080/13645706.2020.1723110.
[38]	LV LL, ZHU LL, CHEN GH, et al. Recanalization of accessory hepatic vein for hepatic vein-type Budd-Chiari syndrome[J]. Abdom Radiol, 2021, 46( 7): 3456- 3463. DOI: 10.1007/s00261-021-02977-1.
[39]	WANG QH, LI K, HE CY, et al. Angioplasty with versus without routine stent placement for Budd-Chiari syndrome: A randomised controlled trial[J]. Lancet Gastroenterol Hepatol, 2019, 4( 9): 686- 697. DOI: 10.1016/S2468-1253(19)30177-3.
[40]	HATZIDAKIS A, GALANAKIS N, KEHAGIAS E, et al. Ultrasound-guided direct intrahepatic portosystemic shunt in patients with Budd-Chiari syndrome: Short- and long-term results[J]. Interv Med Appl Sci, 2017, 9( 2): 86- 93. DOI: 10.1556/1646.9.2017.2.14.
[41]	DARWISH MURAD S, LUONG TK, PATTYNAMA PMT, et al. Long-term outcome of a covered vs. uncovered transjugular intrahepatic portosystemic shunt in Budd-Chiari syndrome[J]. Liver Int, 2008, 28( 2): 249- 256. DOI: 10.1111/j.1478-3231.2007.01649.x.
[42]	QI XS, GUO WG, HE CY, et al. Transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome: Techniques, indications and results on 51 Chinese patients from a single centre[J]. Liver Int, 2014, 34( 8): 1164- 1175. DOI: 10.1111/liv.12355.
[43]	SHARMA S, TEXEIRA A, TEXEIRA P, et al. Pharmacological thrombolysis in Budd Chiari syndrome: A single centre experience and review of the literature[J]. J Hepatol, 2004, 40( 1): 172- 180. DOI: 10.1016/j.jhep.2003.09.028.
[44]	ZHU RQ, NI N, HUANG W. Current status and choice of diagnosis and treatment of budd chiari syndrome[J]. World Latest Med Inf, 2018, 18( 26): 34- 36. DOI: 10.19613/j.cnki.1671-3141.2018.26.017. 朱瑞琪, 倪念, 黄文. 布加综合征诊治现状及治疗选择[J]. 世界最新医学信息文摘, 2018, 18( 26): 34- 36. DOI: 10.19613/j.cnki.1671-3141.2018.26.017.
[45]	LANGLET P, VALLA D. Is surgical portosystemic shunt the treatment of choice in Budd-Chiari syndrome?[J]. Acta Gastroenterol Belg, 2002, 65( 3): 155- 160.
[46]	ARA C, AKBULUT S, INCE V, et al. Living donor liver transplantation for Budd-Chiari syndrome: Overcoming a troublesome situation[J]. Medicine, 2016, 95( 43): e5136. DOI: 10.1097/MD.0000000000005136.
[47]	ATTWELL A, LUDKOWSKI M, NASH R, et al. Treatment of Budd-Chiari syndrome in a liver transplant unit, the role of transjugular intrahepatic porto-systemic shunt and liver transplantation[J]. Aliment Pharmacol Ther, 2004, 20( 8): 867- 873. DOI: 10.1111/j.1365-2036.2004.02190.x.
[48]	MANCUSO A. In favour of early intervention for Budd-Chiari syndrome: Another brick in the wall[J]. Eur J Gastroenterol Hepatol, 2016, 28( 7): 850- 851. DOI: 10.1097/meg.0000000000000653.
[49]	RAUTOU PE, MOUCARI R, ESCOLANO S, et al. Prognostic indices for Budd-Chiari syndrome: Valid for clinical studies but insufficient for individual management[J]. Am J Gastroenterol, 2009, 104( 5): 1140- 1146. DOI: 10.1038/ajg.2009.63.