肝段下腔静脉全程显露的布加综合征根治术远期疗效

Long term outcomes of Budd-Chiari syndrome patients undergoing radical resection with full exposure of the inferior vena cava of the hepatic segmen

目的分析布加综合征（Budd-Chiari syndrome，BCS）根治术后远期效果及术后病变复发的危险因素。方法回顾性分析自2001年7月至2010年12月在北京大学人民医院血管外科接受布加综合征根治术的83例患者的临床资料，统计患者生存情况及下腔静脉（inferior vena cava．IVC）、肝静脉（hepatic vein，HV）通畅情况，分析布加综合征根治术后远期病变复发危险因素。结果围手术期死亡5例（6％）。肝功能Child C级为围手术期死亡危险因素（P=0．001）。平均随访时间60-173（84±35）个月。8例（10．3％）患者失访，随访死亡10例（12．8％），肝功能Child C级为随访期死亡危险因素（P=0．003），随访长期生存患者60例，24例（40．0％）患者病变复发，其中下腔静脉病变复发12例（20．0％），肝静脉病变复发2例（3．3％），下腔静脉及肝静脉病变同时复发10例（16．7％）。COX回归分析提示下腔静脉隔膜型病变（P=0．004）、术后抗凝时间不足12个月（P=0．004）为下腔静脉再狭窄危险因素。结论布加综合征根治术后复发率较高，下腔静脉隔膜型病变、术后抗凝疗程短为根治术后下腔静脉复发狭窄的危险因素。

Objective To analyze the long-term curative effect of radical surgery for Budd-Chiari syndrome and the postoperative recurrence risk factors. Method Clinical data of 83 patients treated with radical surgery for Budd-Chiari syndrome through exposure of the entire inferior vena cava of the hepatic segment at Peking University People＇s Hospital between Jul 2001 and Dec 2010 was studied. Survival rate, patency rate of the inferior vena cava and hepatic vein, and risk factors were analyzed. Results There were 5 perioperative deaths with a mortality rate of 6%. Child-Pugh C liver function （ P = 0. 001 ） was independently related to the perioperative death. The mean follow-up time was 84 ＋ 35 （60 - 173 ） months. There were 8 patients （ 10. 3% ） lost to follow-up. 10 patients （ 12. 8% ） died during follow-up. Child-Pugh C liver function （P = 0. 003） was independently related to the follow-up death. 24 cases （40%） suffered from recurrence with inferior vena cava restenosis in 12 cases （ 20% ）, that of hepatic vein in 2 cases （3.3%） , and 10 cases （ 16. 7% ） with both inferior vena cava and hepatic vein restenosis. Membranous lesion of inferior vena cava （ P = 0. 004 ） and inadequate anticoagulation time （ P = 0. 004 ） were independently related to the recrudescence. Conclusions Long term recurrence of Budd-Chiari syndrome after radical surgery through exposure of the entire inferior vena cava of the hepatic segment is related to membranous lesion of inferior vena cava and inadequate anticoagulation time.