医源性第二肝门阻塞的手术治疗

Surgery for iatrogenic obstruction of the second hepatic portal

目的探讨医源性第二肝门阻塞性疾病手术治疗的方法与疗效.方法总结了近6年来收治的医源性第二肝门阻塞的患者7例,其中第二肝门支架移位完全遮蔽肝静脉回流4例,残留导丝局部血栓和内膜增生后肝静脉闭塞3例;我们采用低温全身麻醉、在停循环状态下经胸部正中切口,在胸膜腔和腹膜腔完整的情况下,完整取出7例患者的异物,同时进行第二肝门成型手术.结果手术后肝脏明显缩小,腹水减少,手术后6个月,腹水完全消失,肝功能正常,超声和CT血管重建肝静脉回流通畅,无狭窄.随访6个月以上1例,6～12个月2例,1～5年3例,随访5年以上1例,均无复发.结论介入治疗支架移位是医源性第二肝门阻塞的常见原因,胸部正中切口异物取出、第二肝门成型是一种较好的根治性手术方法.

Objective To summarize the effects of surgery for iatrogenic obstruction of the second hepatic portal and the curative effects thereof. Methods Seven patients, 5 males and 2 females, aged 25 - 38, with iatrogenic obstruction of the second hepatic portal, due to blocking of the reflux of hepatic vein by translocated stent in 4 cases and due to occlusion of hepatic vein local thrombosis and endometrial hyperplasia caused by broken wires in 3 cases, underwent removal of the foreign bodies and plastic operation of the second hepatic portal under temporary circulatory pause and hypothennic general anesthesia via the approach of incision of the pericardium and inferior vena cava. The patients were followed up for 6 months to 5 years. Results After the operation the liver shrank and ascites was decreased significantly in all patients. The liver functions of all patients were normal during the follow-up and no complication or signs of recurrence were found. Ultrasonography and CT scan showed no stricture and stenosis. Conclusion Translocation of stent is the common reason of iatrogenic obstruction of the second hepatic portal. Operational procedure including removal of the foreign bodies and plastic operation of the second hepatic portal under temporary circulatory pause and hypothennic general anesthesia via the approach of incision of the pericardium and inferior vena cava is an effective radical surgical treatment for this complication.