介入和外科手术治疗布加综合征39例诊治体会

Interventional and Surgical Treatment of Budd-Chiari Syndrome:A Report of 39 Cases

目的总结介入治疗、根治术、转流减压术治疗布加综合征(Budd-Chiari syndrome,B-CS)的诊治经验。方法回顾性分析39例BCS患者的临床资料,其中行介入治疗15例,根治手术9例,转流手术15例。结果手术均一次性获得成功,围手术期死亡率0%,下腔静脉压力平均下降14.8(5～24)cmH2O。所有病例术后症状、体征不同程度消退。随访32例,13例基本恢复正常生活,11例可从事轻度体力劳动,8例不能从事体力劳动但生活可自理。1例胸腔积液反复出现,术后1年基本消失,遗留胸廓塌陷。1例根治术后复发,拒绝再次手术治疗,随后失访。结论介入治疗逐渐成为B-CS的首选术式,但根治术和转流术等外科术式也各有其适应证和不可替代性。临床工作中应根据病理类型和血流动力学变化特征,制定个体化的最佳手术方案。

Objective To explore the indications and effects for interventional and surgical treatment of Budd-Chiari syndrome.Methods A retrospective analysis of the clinical data of 39 B-CS patients treated by interventional and surgical therapy has been carried out.Among these patients,percutaneous transinferior vena cava angioplasty was performed in 3 cases,inferior vena cava PTA with stent deployed in 12 cases,radical resection in 9 cases,shunt or bypass procedure in 15 cases.Results The immediate successful rate for interventional and surgical treatment was 100%.The perioperative mortality was 0%.The inferior vena cava pressure was reduced by 5～24 cm H2O.A follow-up study showed that 13 cases returned to normal life,11 could be engaged in light manual work,8 could not do any manual work but take care of themselves.Among the radical resection group,one had recurrent pleural effusion until one year postoperatively,another had a relapse and was lost to follow-up thereafter.Conclusions Interventional therapy may be the first choice for most B-CS patients,but surgical treatment including radical resection and shunt also has their indications and unreplacement.Patients with different clinical types and different hemodynamic changes should be undergone different operations.