布-加综合征术后复发的防治:附223例报告

Prevention and treatment of postoperative recurrence of Budd-Chiari syndrome :a report of 223 cases

目的 探讨布 -加综合征 (BCS)术后复发的常见原因和防治原则。方法 对 2 2 3例BCS术后复发病人的临床资料进行回顾性分析。其中Ⅰa型 66例 ,Ⅰb型 48例 ,Ⅱ型 5 7例 ,Ⅲa型 2 8例 ,Ⅲb型 2 4例 ;2次以上手术后再复发 3 6例。结果 再次手术均获成功 ,无围手术期死亡。随访182例 ,随访时间 6个月～ 10年 ,有效率 89.6% ,复发率 6.0 % ,死亡 8例。结论 术前不能正确进行分型、手术适应证选择不当和术中操作技术不规范等是导致复发的主要原因。布 -加综合征术前正确进行分型 ,根据分型选择恰当的手术方法 ,术中血管吻合采用间断、褥式、外翻缝合方法等对防止术后复发很重要。

Objective To investigate the causes,prevention and management principles of postoperative recurrence of Budd Chiari syndrome(BCS).Methods The clinical data of 223 postoperative recurrence BCS patients were analyzed retrospectively,including type Ia in 66 cases,type Ib in 48 cases,type II in 57 cases , type IIIa in 28 cases,and type IIIb in 24 cases. Of them,36 patients underwent two or more operations .Results Secondary operations were all successful.No patient died in the perioperative period. One hundred and eighty two patients were followed up for 6 months to 10 years.In 89.6% of the patients,the results were successful,but the recurrence rate after the reoperation was 6.0%,and 8 patients died postoperatively .Conclusions The main recurrent causes are that indications are not correctly selected and the operative technique is not correct. Correct classification,reasonable selection of the operation method, and adopting an interruptive,matress,and eversive suture for blood vessels anastomosis in the operation are important to prevent the recurrence of BCS.