布—加氏综合征根治性术式的探讨

The exploration of radical operation for the Budd-chiari Syndrome

目的:统计布—加氏综合征直视下根治术的45例资料,并探讨三种根治性手术的优缺点及适应症。方法:隔膜切除或病变的下腔静脉段切开、心包片扩大成形17例;闭塞或狭窄的下腔静脉段切除、人工血管原位移植24例;肝静脉流出道成形6例。同时行肝静脉至右心房的下腔静脉入口处人工血管间置移植4例。结果:因术后并发症死亡2例;复发4例,均为心包片扩大成形术后的病人。结论:心包片成形术适用于隔膜型,人工血管原位移植适用于短段闭塞或狭窄型,肝静脉流出道成形可用于长段下腔静脉闭塞型。

Objective:This paper presents our clinical experience of 45 patients with BCS underwent radical operation, to explore advantage and disadvantage of 3 groups. Methods: Membranectomy and pericardial patch cavoplasty in 17 cases. Resection of IVC with occlusion or narrow and origical graft with artifical vascular graft in 24 cases. Hepatic venout plasty in 6 cases, original graft with artifical vascular graft from hepatic venout to IVC' s inlet of right atrium in 4 cases. Results: 2 cases died. By follow - up, 4 cases recurrence. The origial graft with artifical vascular graft is superior to pericardical patch cavoplasty. Conclusion: The indication of membranectomy and pericardial patch cavoplasty is indicated for membranous obstruction,resection of IVC with occlusion or narrow and original graft for short segmental obstruction. Hepatic venout plasty is for long segment obstruction of IVC with main hepatic vein obstruction.