肠系膜上静脉-下腔静脉C形架桥联合门-奇断流术治疗肝静脉闭塞型布-加综合征

Mesocaval C-shunt with artificial vascular graft plus portaazygous disconnection in the treatment of Budd-Chiari syndrome

目的 :探讨一种新的治疗肝静脉闭塞型布 加综合征的手术方式。方法 :对 88例肝静脉闭塞型布 加综合征患者采用人工血管肠系膜上静脉 下腔静脉C形架桥联合门 奇断流术、脾动脉结扎或脾大部切除术进行治疗。结果 :所有患者均顺利完成手术。分流前平均门静脉压为 36cmH2 O(31～ 45cmH2 O ,1cmH2 O =0 .0 0 98kPa) ,分流后为 2 6cmH2 O(2 1～ 33cmH2 O) ,平均下降 1 0cmH2 O。 3例死于术后并发症 ;8例发生乳糜漏 ,于术后 5d～ 3个月恢复正常。 74例随访 0 .5～ 7a ,无肝性脑病和复发出血。腹水消失 61例 ,明显减少 1 3例 ,彩超检查人工血管均通畅。结论 :此手术方式是治疗肝静脉闭塞型布 加综合征较简单。

Aim: To study the operation program of Budd Chiari syndrome (B CS) with hepatic venous occlusion. Methods:A total of 88 cases of B CS with hepatic venous occlusion underwent combined mesocaval C shunt with artificial vascular graft, pericardial devascularization, ligation of splenic artery or subtotal splenectomy. Results: The operation was successful in all patients. The mean free portal venous pressure was 36 cmH 2O(31～45 cmH 2O) and postshunt pressure fell to 26 cmH 2O(21～33 cmH 2O), the mean reduction was 10 cmH 2O. 3 patients died of operative complications. Chylorrhea occurred in 8 patients who recovered 5 days to 3 months after operation.A total of 74 patients were followed up for 6 months to 7 years,and there was no recurrent bleeding and hepatoencephalopathy occurrence. Ascites disappeared in 55 cases, and markedly reduced in 13 cases. The graft diagnosed as unobstructed by color Doppler ultra sound in all followed up patients. Conclusion: The operation is simple and effective for B CS with hepatic venous occlusion