肝段下腔静脉阻塞症的造影检查和外科治疗选择——附24例报告

VENA CAVOGRAPHY AND SURGICAL TREATMENT IN HEPATIC LEVEL OCCLUSION OF INFERIOR VENA CAVA

本文将1977年11月～1988年5月收治的24例肝段下腔静脉阻塞症的诊治情况作一简单总结。22例经双向下腔静脉造影证实,2例根据B超和临床征象作出诊断。本组患者发病年龄平均28岁。隔膜型阻塞有7例,其余17例为长段阻塞。8例作了下腔静脉和/或肠系膜上静脉—右心耳人造血管架桥术(聚四氟乙烯人造血管4例,丝涤交织人造血管4例),3例作了下腔静脉隔膜破膜术。经3年随访,除术后近期死亡2例外,7例症状有不同程度的改善,另2例分别于术后1年半和3年症状复发。

Twenty-four cases of hepatic level occlusion of the inferior vena cava were treated during Nov. 1977 to May 1988. Twenty-two cases were diagnosed by inferior vena cavography and 2 by B ultrasonography. Seven patients had membranous obstruction and 17 long segment obstruction. Eight patients were treated by cavoatrial and/or mesoatrial shunts (silk-dacron prothesis in 4 and PTFE in 4). Three cases of membranous obstruction had finger membranotomy. Varices in legs and abdominal wall completely or partially disappeared and ascites subsided in 7 operated cases at three years. One had recurrence of symptoms 18 months after a cavoatrial shunt and another had recurrence 3 years after a finger membranotomy. Two patients died during early postoperative period. Inferior vena cavography is the examination of choice for diagnosis and selection of appropriate surgical procedure. Patients with minimal ascites, palpitation, shortness of breath and leg edema are good candidates for surgery. A PTFE prosthesis is the graft of choice for cavoatrial shunt.