脾静脉-颈内静脉转流术治疗重症布加-综合征

Spleen-internal jugular venous shunt in the treatment for severe Budd-Chiari syndrome

目的 :探讨下腔静脉节段闭塞或狭窄并弥漫性肝静脉闭塞引起的重症布 加综合征的手术方式。方法 :对 38例重症布 加综合征患者采用脾切除、脾静脉 颈内静脉胸骨后转流术进行治疗。结果 :围手术期死亡 1例 ,病死率 2 .6 % ;2例发生切口感染 ,1例发生急性心功能衰竭 ,经药物治愈 ;余 37例患者术后临床症状均有不同程度改善。对 35例患者术后随访 6～ 36个月 ,效果优者 2 3例 (65 .7% ) ,患者临床无症状 ,腹水、胸腹壁曲张静脉及下肢肿胀消失 ,肝右肋下不能触及 ;良好者 1 0例 (2 8.5 % ) ,胸腹壁曲张静脉基本消失 ,肝脏缩小 ;2例效果不佳(5 .7% )。结论 :脾静脉 颈内静脉转流术是治疗重症布

Aim: To evaluate operative treatment method for severe Budd Chiari syndrome caused by long segmental occlusion or lesion of inferior vena cava and diffuse hepatic veins obliteration. Methods: A total of 38 patients with severe Budd Chiari syndrome were treated by splenectomy and spleen internal jugular venous shunt with blood vessel prothesis. Results: One patient died during the operation.A total of 35 cases were followed up for 6 to 36 months. The results of 23 cases were excellent (65.7%), and the patients had no clinical symptoms, ascites, dilated tortuous veins in the abdomen and chest, or edema of lower extremities.The liver was not palpable below the right costal margin.Dilated tortuous veins in the abdomen and chest relieved,and the liver reduced in size after treatment in 10 patients. Two were noneffective(5.7%). Conclusion: Spleen internal jugular venous shunt is effective for the patients with severe Budd Chiari syndrome.