直视下Budd-Chiari综合征根治术术式选择

Choice of Curative Operative Procedure in Budd-Chiari Syndrome

目的：探讨Ｂｕｄｄ－Ｃｈａｉｒｉ综合征（ＢＣＳ）４种根治术的适应证及其优缺点。方法：１９９３年１１月～２０００年１２月对１１４例ＢＣＳ病人行直视下根治术，其中单纯隔膜切除２０例，下腔静脉病变段切开、心包片成形３９例，下腔静脉病变段切除、人工血管原位移植４２例，肝静脉主干闭塞段及其上方的下腔静脉闭塞段切除、肝静脉流出道扩大成形、肝静脉开口至下腔静脉的右房入口处人工血管原位移植术１３例。结果：全组无手术死亡。住院期间４例死于并发症。随访６～８４个月，复发５例，２例无效，均为心包片扩大成形术后。结论：４种根治术有各自不同的适应证。合理的术式选择是取得良好远期疗效的关键。

Objective: To investigate the indication, advantage and disadvantage of different radical operative procedures in Budd-Chiari syndrome(BCS). Methods: During the period from November 1993 through December 2000, 114 cases of BCS underwent open operative intervention. The number of cases undergoing membranectomy, incision of the involved inferior vena cava(IVC) segment with pericardial patch angioplasty, and resection of the diseased IVC segment with orthotopic vascular graft were carried out in 20, 39 and 42 cases respectively. Resection of the occluded hepatic vein and suprahepatic IVC segment, followed by orthotopic graft transplantation between the hepatic vein(HV) outflow and the right atrium was carried out in 13 patients. Results: There was no peroperative death. Four cases died of postoperative complications during hospitalization. Five cases recurred 6～84 months after operation. Conclusions: There are various indications in the four radical procedures and each has its own indication. A rational choice of the appropriate procedure is the key to good long-term outcome.