胸部正中切口布加氏综合征根治术远期疗效观察

The follow-up of the patients with Budd-Chiari syndrome receiving radical operation through midsternal incision approach

目的 观察胸部正中切口布加氏综合征根治手术的远期疗效 ,总结根治肝静脉阻塞型布加氏综合征的临床经验 ,探讨一种安全有效的手术方法。方法 3 0例在不切开胸膜腔和腹腔的情况下 ,经胸部正中切口 ,仅行心包、下腔静脉切开 ,在膈下腹膜外间隙内显出下腔静脉或肝静脉病变 ,在停循环状态下进行局部病灶切除 ,恢复肝脏血液回流 ,当时即见肝脏张力减小、肝脏体积缩小。对存活病例每 6个月随访观察 ,进行肝脏及第二肝门血管彩超或核磁共振检查。结果 2 9例获得临床治愈 ,随访 1～ 10年 ,均健康存活 ,无并发症 ,无复发 ;1例术后 2周因黄疸、应急性溃疡消化道出血死亡。结论 胸部正中切口是一种比较理想的根治肝静脉阻塞型布加氏综合征的手术入路 ,安全、有效、创伤小、远期效果良好。

Objective To observe the long-term follow-up results of the operated patients with Budd-Chiari syndrome of hepatic stenosis,and to summarize the experience of radical operation through midsternal incision approach under the deep hypothermia and temporally circulatory pause,and to investigate the safe and effective radical operation for Budd-Chiari syndrome of hepatic stenosis.Methods The clinic data was analyzed retrospectively.The foci of 30 cases were clearly exposed and resected through midsternal incision approach under the temporally circulatory pause with incising the pericardium and inferior vena cava only without opening the thoracic cavity or abdominal cavity.The livers diminished and the liver venous reflux became normal just after operation.The live operated patients were followed up from 1 to 10 years,and the hepatic veins of second hepatic portal were checked up every 6 months by color ultrasound or the magnetic resonance imaging.Results Twenty-six cases were cured with no complication or recurrence except for one case died of stress ulcer.Conclusion It is a better radical operation of safety,effectiveness,minitrauma and quick recovery on patients with Budd-Chiari syndrome of hepatic venous stenosis. [