根治布－加综合征的新术式

A new radical operation for Budd Chiari syndrome

虽然文献已报告治疗布－加综合征（Ｂｕｄｄ－Ｃｈｉａｒｉｓｙｎｄｒｏｍｅ）的手术有１０余种，但大多数疗效欠佳，不是治标不治本，达不到根治目的，就是损伤太大，手术死亡率高，难以被采纳。为此，我们设计了在体外循环深低温的条件下，停止循环后施行布－加综合征根治术式。本术式只正中纵行劈开胸骨，切开心包，切开肝静脉上段之下腔静脉，由于循环停止，下腔静脉腔内已无血，能清楚识别病灶，并在下腔静脉腔内彻底清除该静脉及肝静脉病灶，恢复下腔及肝静脉的正常血流，达到根治目的。自１９９３年９月～１９９５年７月，８例患者接受手术，都取得良好效果。随诊２～２３个月，平均１８个月，术后２个月可以从事正常工作或较强的劳动，无症状复发。彩色多普勒超声检查肝静脉、下腔静脉通畅。我们认为本术式的优点是：只开胸不开腹，在下腔静脉腔内施行根治术的创伤小，出血少，手术时间短。手术野无血，直视下切除病变，能达到极满意的效果；术后处理简单，康复快。

Although there are several operations used to treat the Budd Chiari syndrome, many of them are not really radical. The radical operation, howeve, either could not eradicate the lesions of inferior vena vava (IVC) and hepatic vein (HVs), or results in more mortality caused by great oprative injury. Therefor, we designed the extracorporeal circulation with deep hypothermia and arrested circolation, then super hepatic inferior vena vava was opened. The lesions of IVC and HVs were resected in the lumen of IVC. From September 1993 to July 1995,8 cases were treated. The results were excellent. The operative advantages included 1. The circulation was arrested which provided bloodless and clear visual field, the lesions were resected easily and completely. 2. The operative injury was relatively less. Because it only needed midline stenotomy, without lqparotomy The incision of the IVC is short, and the lesions of the HVs and IVC were resected in the lumen of the IVC. 3. The operation was safe without deah and complication. 4. The oparetive effect was very good. These patients returned to their normal work 2 months after operation. The follow-up time averaged 18 months, the IVC and HVs were patent without any symptom.