肝素化后自体血液回收并回输下布-加综合征根治术疗效及其临床意义

Curative effect and clinical significance of autologous blood recovery after heparinization and reinfusion of radical operation for Budd-Chiari syndrome

目的探讨肝素化后自体血液回收并回输下布-加综合征(BCS)根治术疗效及其临床意义。方法收集1997年11月至2016年8月简阳市人民医院行肝素化后自体血液回收并回输下BCS根治术69例患者的临床资料,观察手术时间、术中库存血液输注情况、手术治疗结果和随访结果。结果手术时间为170(140,195)min;3例患者术中分别输注了库存血液1800 ml、1100 ml和400 ml,其余66例患者术中均未输注库存血液;共67例患者术后下肢深静脉压力为(10.4±1.4)mmHg,低于术前(25.5±3.6)mmHg,差异有统计学意义(P<0.01);围术期死亡2例;随访5~10年,1例术后4年死于肝癌,2例复发,其余病例术前症状、体征消失或显著缓解,疏通部位下腔静脉和肝静脉回流满意。结论BCS根治手术是符合生理的治疗方式,非体外循环下肝素化后自体血液回收并回输技术可确保其顺利实施。

Objective To investigate the curative effect and clinical significance of autologous blood recovery after heparinization and reinfusion of radical operation for Budd-Chiari syndrome(BCS).Method The clinical data of 69 patients who underwent BCS radical operation after heparinization in the People's Hospital of Jianyang from November 1997 to August 2016 were collected.The operation time,intraoperative blood transfusion status,surgical treatment results,and followup results were observed.Result The operation time was 170(140,195)minutes;three patients received 1800 ml,1100 ml,and 400 ml of bank blood during the operation,respectively,while the remaining 66 patients did not receive any blood during the operation.A total of 67 patients had postoperative lower extremity deep venous pressure among(10.4±1.4)mmHg,which was significantly lower than the preoperative whose value was(25.5±3.6)mmHg,and the difference was statistically significant(P<0.01).Two patients died in the perioperative period.During the follow-up of 5 to 10 years,one patient died of liver cancer four years after the operation,and two patients recurred.The preoperative symptoms and signs of the remaining patients disappeared or were significantly relieved,and the drainage of the inferior vena cava and hepatic vein was satisfactory.Conclusion BCS radical surgery is a physiological treatment,and the technology of heparinized autologous blood recovery and reinfusion under off-pump bypass could ensure its successful implementation.