肝素化后自体血回收回输施行布加综合征根治术57例分析

Open angioplasty of Budd-Chiari syndrome with self-blood recovery and transfusion after heparinization:an analysis of 57 cases

目的总结肝素化后自体血回收、回输施行布加综合征(BCS)根治术的临床治疗经验。方法回顾分析1997年11月至2011年5月简阳市人民医院心血管外科在非体外循环下实施57例BCS根治术病人的临床资料。手术要点是在全身肝素化前提下,实现下腔静脉远端球囊阻断、控制性放血、负压吸引血液回收、经右心插管血液回输等关键技术环节,同时在直视下完成对下腔静脉、肝静脉阻塞性病变的处理。结果术前下肢深静脉压力(17.5～30.3)mmHg(1mmHg=0.133kPa),平均(25.3±3.6)mmHg,术后下降为(9～13)mmHg,两者差异有统计学意义。术中回收回输自体血量600～40000mL,其中超过10000mL者8例;除1例术中发生下腔静脉破裂、大量失血而于术中、术后输异体血外,其余病人术中均未输异体血。无上消化道大出血、肝昏迷、急性肾功能衰竭、肺动脉栓塞等手术并发症。围手术期死亡1例(1.82%),死于不能有效控制的下腔静脉破裂出血。结论肝素化后自体血回收、回输技术简化了体外循环和深低温停循环下BCS根治术的手术程序,保证了手术效果。

Objective To summarize the experience of treatment on open angioplasty of Budd-Chiari syndrome （BCS） in heparinization and no cardiopulmonary bypass （N-CPB）. Methods The clinical data of 57 cases of BCS performed open angioplasty in heparinization and N-CPB from November 1997 to May 2011 at the People＇s Hospital of Jianyang were analyzed retrospectively. The operation includes following key points： heparinization of blood but N-CPB, blocking the distal side of the obstruction in inferior vena cava by a Foley＇ s catheter, blooding controlled, blood retrieved by negative pressure and the blood transfused through the cannulas in right atrium. Results The inferior vena cava pressure dropped obviously （from 17.5-30.3 mmHg to 9-13 mmHg） with significant difference. Self-blood volume transfused 600-40 000 mL in per case. The self-blood volume transfused was over 10 000 mL in 8 cases. All cases didn＇ t transfuse stocking blood in operating period except for 1 case. There were not serious complications occuIred including upper gastrointestinal haemorrhage, hepatic coma, acute renal failure and pulmonary artery embolism, ect. One case （1.82%） died in 24 hours after operation due to bleeding of inferior vena cava. Conclusion Compared with the way in CPB and deep hypothermic circulatory arrest, open angioplasty with self-blood recovery and transfusion after beparinization may simplify processes on open angioplasty of BCS, reduce operating injury and ensure the effect of operation.