第二肝门肝静脉医源性异物阻塞的手术探讨

Surgical Treatment for Hepatic Venous Obstruction of Second Hepatic Portal Due to Iatrogenic Foreign Body

目的 探讨第二肝门医源性肝静脉阻塞的手术治疗方法，总结外科治疗体会。方法 1998年1月至2005年11月收治7例医源性第二肝门阻塞患者，其中支架移位完全遮蔽肝静脉回流4例，残留导丝致肝静脉闭塞3例；均在全身麻醉下经胸部正中切口，切开第二肝门部的腔静脉上段，完整取出异物，同时切除局部病灶。结果 手术后肝脏明显缩小，腹水减少；术后6个月，腹水完全消失，肝功能正常，超声和CT示血管肝静脉回流通畅，无狭窄。分别随访6月以上1例，6～12月2例，1～5年3例，5年以上1例，均无复发。结论 经胸部正中切口切开第二肝门部上段腔静脉，清除异物和原发病灶后修复腔静脉，是一种较好的矫正医源性肝静脉异物阻塞的手术方法，值得推广应用。

Objective To investigate the surgical treatment for the hepatic venous obstruction of second hepatic portal due to iatrogenic foreign body. Method 7 cases of hepatic venous obstruction of second hepatic portal due to iatrogenic foreign body were surgical treated from January 1998 to November 2005, the pathogenesis were complete blocking by dislocated stent in 4 cases, partial occlusion by residual guide wire in 3 cases. The surgery conducted under general anesthesia via a midline incision, the suprahepatic inferior vena cava was incised and the foreign bodies removed then followed by ablation of primary pathological change. Result Liver reduced in size after surgery, ascites reduced and vanished at 6 months postoperatively along with the normalization of liver function. The hepatic vein screened as patent under ultrasound and CT. No recurrence was observed in consistent with follow-up of 6 months, 12 months, 1 - 5 years and over 5 years in 1, 2, 3 and 1 case respectively. Conclusion This procedure is recommendable for the hepatic venous occlusion by iatrogenic foreign body.