联合腔肠房人工血管转流术治疗布加综合征14例体会

Cavo-meso-atrial shunt for the treatment of Budd-Chiari syndrome due to combined occlusion of inferior vena cava and hepatic vein

目的探讨联合腔肠房人工血管转流术在中青年患者因下腔静脉血栓形成致下腔静脉和肝静脉回流障碍型布加综合征的应用。方法本组 14例 ,平均年龄 2 8 6岁。均为肝段或长段下腔静脉血栓形成致肝静脉出口阻塞 ,其中 12例下腔静脉完全阻塞 ,2例为肝段下腔静脉严重狭窄。采用 3种腔肠房人工血管转流术 ,分别应用 11例 ,1例和 2例。结果围手术期无死亡。随访时间4～ 5 2个月 ,平均 2 4个月。方法 (1)术后 2例人工血管血栓形成 ,1例最后改行腹膜腔颈内静脉腹水转流术 ;另 1例并发上消化道出血 ,肝昏迷死亡。随访期死亡率为 7%。总人工血管通畅率为 86 % ,而腔房人工血管的通畅率为 93%。本组患者门静脉压力下降范围为 5～ 2 6cmH2 O ,平均下降 15 5cmH2 O ,无其他严重并发症。结论对于下腔静脉长段血栓致下腔静脉和肝静脉回流障碍的中青年患者 ,联合腔肠房人工血管转流术不失为一种能同时缓解门脉和下腔静脉高压的手术方法。

Objective To investigate the efficacy of cavo-meso-atrial shunt for the treatment of Budd-Chiari syndrome (BCS) with occlusion of both inferior vena cava (IVC) and hepatic veins (HVs) lesions. Method 14 cases with BCS due to combined occlusion of IVC and HVs were treated from 1996. 8 cases were male and 6 cases female.The age ranged from 20 to 36 years old. HVs occlusion with complete IVC occlusion was found in 12 cases and stenosis of IVC in 2 cases. Cavo-meso-atrial shunt was performed. Result There was no perioperative death. Thrombosis of graft occurred in two cases, one died of upper digestive tract bleeding and hepatic coma half year post-operation. The mortality rate at follow-up period was 7%, the total patency of graft was 86% and the patency of cavo-atrial graft was 93%. The decrease in portal vein pressure was between 5 to 26 cmH 2O with an average of 15.5 cmH 2O. No serious complications occurred. Conclusion The cavo-meso-atrial graft shunt is an alternative to treat patients with occlusion of both IVC and HVs due to IVC thrombosis. The long term patency remains to be evaluated.