低温停循环第二肝门成型根治肝静脉阻塞型布加综合征初探

Preliminary study on radical operation on patients with Budd-Chiari syndrome under deep hypothermia and temporally circulatory pause

目的 总结在深低温全身麻醉、体外循环辅助下 ,第二肝门成型根治肝静脉阻塞型布加综合征的临床治疗体会。方法 回顾 16例初步应用本项手术的临床资料 ,经胸部正中切口 ,切开胸骨 ,在不打开胸膜腔和腹膜腔的情况下 ,仅行心包、下腔静脉切开 ,显出第二肝门病变和下腔静脉病变 ,在暂时停循环状态下进行局部病灶切除和第二肝门血管重建。结果 手术中恢复肝静脉回流后即见肝脏明显缩小 ,膈肌表面代偿静脉支瘪缩 ;随访 6个月至 7年 ,无 1例死亡或并发症发生 ,无 1例复发 ,均获得临床治愈。结论 深低温停循环状态下、第二肝门血管成型是一种理想的根治肝静脉阻塞型布加综合征的手术方法 ,安全、有效、创伤小、恢复快、符合解剖和生理需要。

Objective To summarize the experience in radical operation on the patients with Budd-Chiari syndrome under deep hypothermia and temporally circulatory pause and to seek a safe and effective radical operation for this disease. Methods The clinical data of 16 patients with Budd-Chiari syndrome treated in our hospital with the method were retrospectively analyzed. Results Without opening the thoracic or abdominal cavity, the foci were clearly exposed and resected and the second hepatic portal system reconstructed under the temporally circulatory pause only through incising the pericardium and inferior vena cava. The liver diminished and the liver venous reflux became normal immediately after the operation. All the patients received operation were followed up for 6 months to 7 years. It was found that there were no death, severe complications or recurrence. Conclusions This method is of high safety, effectiveness, minimal trauma and quick recovery for treatment of patients with Budd-Chiari syndrome.