布加综合征452例术后并发症的处理

Management of post operative complications of Budd Chiari syndrome:experience of 452 cases

目的 探讨布加综合征术后并发症的预防和治疗经验。 方法 从１９９１ 年７ 月至１９９８年３ 月，我院共收治４５２ 例患者，男２６０ 例，女１９２ 例，年龄２～７２ 岁，平均３２－７ 岁。根据病理分型和临床分期，共施行各种手术３９７ 次。主要的术式包括肠房转流术（７８ 例），腔房转流术（６５ 例），肠腔分流术（４１ 例） ，肠颈转流术（３６ 例） ，根治术（３１ 例） ，联合破膜术或加支架置入（２１ 例），球囊扩张加支架置入术（１０５ 例），肠腔分流加支架置入（１０ 例） ，脾房分流术（２ 例） 。 结果 术后主要并发症１２９ 例，发生率为３２－５％ 。２２ 例在术后１ 个月内因肝肾综合征等严重并发症而死亡，病死率为５－５％ 。有１８ 例因并发症再次手术，其余患者经各种治疗后恢复良好。 结论 布加综合征术后可发生较多并发症，但只要仔细观察，认真处理。

Objective To sum up our experience on the management of post operative complications of Budd Chiari syndrome.Methods From July 1991 to March 1998, 452 patients with Budd Chiari syndrome were treated. There were 260 males and 192 females,age ranged from 2 to 72 years with a mean of 32 7. According to pathological classification and clinical manifestation, 397 patients were treated surgically or interventionally.The main therapeutic methods were mesoatrial shunt(78),cavoatrial shunt(65), mesocaval shunt(41), mesojugular shunt(36),curative radical resection(31), combined membranotomy and stents (21),PTA and stents(105), mesocaval shunt and stent(10), splenoatrial shunt(2).Postoperative complications occurred in 129 cases(32 5%), including hemathorax, cardiac insufficiency, hepato renal syndrome, and graft occlusion,et al.Results 22 patients (5 5%) died of serious complications within a month after surgery. Reoperation was performed in 18 cases because of hemathorax and graft occlusion,and others were cured by conservative methods.Conclusion A variety of complications could develop after surgery or intervention, but the most of them can be prevented and cured by means of prophylactic management and effective treatment.