Ⅱ型布加综合征患者肝流出静脉通畅度与腔房转流术疗效的关系

Relationship between hepatic venous patency and atrial caval shunting curative effects in patients with type Ⅱ Budd-Chiari syndrome

目的探讨Ⅱ型布加综合征（BCS）患者肝流出静脉通畅度与腔房转流术（ACS）疗效的关系.方法回顾性分析209例应用ACS治疗的Ⅱ型BCS患者的临床资料,患者分为肝流出静脉通畅组（A组）及肝流出静脉狭窄组（B组）.观察并比较患者手术前后的临床症状、门静脉压力（PFP）及下腔静脉压力（IVCP）,患者术后并发症发生率、人工血管通畅率.两组患者手术前后IVCP、PFP的比较采用t检验,人工血管累计通畅率采用χ^2检验及Kaplan-Meier进行分析.结果209例患者中183例临床症状消失或缓解;6例出现严重并发症,其中1例患者围手术期死于肺栓塞.A组患者术后2周PFP下降较B组明显[A组（2.09±0.33）kPa,B组（2.97±0.41）kPa;（t=15.48,P〈0.05）],门脉高压症状显著缓解;术后5年人工血管通畅率为80.0%,且A组高于B组（χ^2=9.32,P〈0.05）.结论肝流出静脉通畅的Ⅱ型BCS患者行ACS,可同时缓解Ⅱ型BCS的门静脉高压症和下腔静脉高压症,且术后并发症少,人工血管通畅率高.

Objective To investigate the relationship between atrial caval shunting (ACS)curative effects for type Ⅱ Budd-Chiari syndrome (BCS)and hepatic venous outflow patency.Methods Two hundred and nine patients undergoing atrial caval shunting for type Ⅱ Budd-Chiari syndrome were retrospectively analyzed and divided into hepatic venous outflow patent group (group A)and stenotic group (group B).The preoperative and postoperative clinical symptoms were observed respectively.χ2 -test,t-test and Kaplan-Meier test were used to analyze the changes of portal free pressure (PFP)and inferior vena cava pressure (IVCP)before and after artificial blood vessels (ABV)opening,incidence of significant postoperative complications and ABV patency rates.Results The clinical symptoms of one hundred and eighty-three BCS patients were disappeared or alleviated.Severe complications occurred in six cases,with one case died from pulmonary embolism.The PFP reduction of group A was significantly lower than that of group B[(2.09 ± 0.33)kPa,(2.97 ±0.41 )kPa;(t =1 5.48,P <0.05 )],and portal hypertension syndromes in group A alleviated more greatly than that of group B.ABV patency was 80.0% for five years after surgery and group A was superior to group B (χ2 =9.32,P<0.05).Conclusions ACS treatment for hepatic venous outflow in patent with type Ⅱ BCS patients could decrease PFP and IVCP simultaneously,with lower postoperative complications and higher ABV patency rates.