经腹肝上下腔与肝后下腔静脉人工血管架桥术治疗Budd-Chiari综合征

Suprahepatic and retrohepatic vena cavocaval bypass by abdominal approach for the short segmental occlusion of inferior vena cava in Budd-Chiari Syndrome

目的：探讨治疗Budd-chiari综合征有效的手术方式。方法：肝后下腔静脉短节段闭塞型Buddchiari综合征，16例采用经腹行肝上下腔静脉与肝后下腔静脉人工血管架桥术（改良手术组），相同病理类型18例应用开胸行右心房与肝后下腔静脉人工血管架桥术（传统手术组），进行疗效对比研究。结果：改良手术组16例中，术中1例急性右心衰，15例术中经过顺利。人工血管长度6～8cm，随访6～55个月人工血管内无血栓形成。传统手术组18例中，术中急性心包填塞1例。术后发生胸腔积液3例，肺部感染与急性心包炎各1例。人工血管长度12～14cm。术后随访60个月，有3例分别于术后37、42、58个月出现人工血管内血栓。结论：经腹腔行肝上下腔静脉与肝后下腔静脉人工血管架桥术临床效果优于传统的开胸行下腔静脉右心房人工血管架桥术，该手术是治疗肝后下腔静脉短节段闭塞型Budd—chiari综合征安全有效的手术方式。

Objective ：To explore the safe and effective method for the treatment of Buddchiari syndrom（Bcs）. Methods ： we performed the new abdominal approach for suprahepatic and retrohepatic inferior vena oavooaval bypass using artificial vessel in 16 BCS patients with short, segmental occlusion of retrohepatic inferior vena oava, and compared it retrospectively with the traditional thoracolaparotomic approach of inferior vena oavoatrial bypass in 18 same pathological type patients. Results：In improvement group （n= 16）, 1 patient had intraoperative acute cardiac failure. The others were not eventful during operation. All patients had no postoperative complications. The length of artificial vessel required was 6 to 8 cm,and all patients had no graft vessel thrombosis after 6 to 55 months follow up. In traditional group（n= 18）, 1 patient had Intraoperative acute pericardial tamponment clue to anastomotic leakage . Three of pleural effusion ,one pulmonary Infection and one acute perioerditls occured post operatlvely. The length of the artifioial vessel required was 12 to 14 cm. Three patients had graft vessel thrombosis at 37,42 and 58 months Post-operation respectively. Conclusion ：The abdominal approach with suprahepatic and retrohepatic cavocaval bypass take advantages over the traclitional thoracolaparotomic approach with cavoartrial bypass. The novel abdominal approach is a safe and effective procedure for treatment of short segmental occlusion of Inferior vena cava in Budd-Chiari syndrome.