布-加综合征外科治疗20年经验总结(附1360例报告)

A 20-year experience with surgical treatment of Budd-Chiari syndrome: A report of 1 360 cases.

目的 探讨布 加综合征合理的临床病理分型、外科治疗方法及原则。方法 对 1983年 5月至 2 0 0 3年 6月收治的 136 0例布 加综合征病人的临床资料进行回顾分析。根据下腔静脉造影和经皮肝穿刺肝静脉造影 ,将其分为 4种类型 (6个亚型 ) :Ⅰa型 5 94例 ,Ⅰb型 12 3例 ,Ⅱ型 2 92例 ,Ⅲa型 2 37例 ,Ⅲb型 112例 ,Ⅳ型 2例。治疗方法包括 :(1)改良脾 肺固定术 2 6 5例 ,(2 )手指破膜或球囊导管扩张 4 0 7例 ,(3)根治性病变隔膜切除和血栓取出术 2 75例 ,(4 )下腔静脉旁路术 88例 (下腔静脉 下腔静脉架桥术 71例 ,下腔静脉 右心房架桥术 17例 ) ,(5 )肠系膜上静脉 下腔静脉C形架桥术192例 ,(6 )脾静脉 下腔静脉架桥术 32例 ,(7)脾静脉 右心房架桥术 2 3例 ,(8)脾静脉 颈内静脉胸骨后 5 7架桥术例 ,(9)肠系膜上静脉 右心房架桥术 8例 ,(10 )联合手术 6例 (包括 :肠系膜上静脉 下腔静脉 右心房架桥术 2例和脾静脉 下腔静脉 右心房架桥术 4例 ,(11)脾静脉 肾静脉分流术 4例 ,(12 )其他手术 3例 (包括肠系膜上静脉 颈内静脉架桥术 2例 )。手术死亡率 3 0 9% (4 2 / 136 0 ) ,并发症发生率 14 78% (2 0 1/ 136 0 )。结果 对 885例进行了随访 ,随访时间 9个月至 15年 ,平均 (6 8± 1 2 )年。总有效率为 89 4 %

Objective To investigate the clinical pathology classification, surgical treatment methods and principles of Budd-Chiari syndrome (B-CS). Methods The clinical data of 1360 patients with B-CS from May 1983 to June 2003 were analyzed retrospectively. Based on inferior veno cavagraphy and percutaneous transhepatic hepatovenography, all patients with B-CS were classified 4 types (6 subtypes). Among them, 594 cases, 123 cases, 292 cases, 237 cases, 112 cases and 2 cases were type Ⅰa, type Ⅰb, type Ⅱ, type Ⅲa, type Ⅲb and type Ⅳ. Surgical treatment methods were as following: (1) 265 cases were performed splenopneumopexy. (2) 407 cases were performed finger or balloon membranotomy. (3) 275 cases were performed radical resection of membrane and thrombus. (4) 88 cases were performed inferior vena cava bypass ( Among them, 71 cases and 17 cases were performed cavocaval shunt and cavoatrial shunt respectively ). (5) 192 cases were performed mesocaval shunt. (6) 32 cases were performed splenocaval shunt. (7) 23 cases performed splenoatrial shunt. (8) 57 cases were performed splenojugular shunt. (9) 8 cases were performed mesoatrial shunt. (10) 6 cases were performed combined operation (2 cases were performed meso-cavo-atrial shunt and 4 cases were performed splenal-cavo-atrial shunt). (11) 4 cases were performed splenorenal shunt. (12) 3 cases were performed other operation (including 2 cases were performed mesojugular shunt). Operation death rate was 3.09% ((42/1360)). Complication rate was 14.78%(201/1360). Results Eight hundreds and eighty-five cases were follow-up from 9 months to 15 years \[average ((6.8±1.2)) years\]. Total effective rate was 89.4% (791/885). Complication occurrence rate was 6.89% ((61/885).) Thirty-three cases died. Conclusion Treatment of B-CS need to get a corrective diagnosis and classification at first, then select corrective methods of operation based on different pathological classification.