自体心包片下腔静脉重建

AUTOLGOUS PERICARDIAL PATCH RECONSTRUCTION OF THE INFERIOR VENA CAVA

目的 探讨自体心包片腔静脉成形 (APPC)或下腔静脉重建 (RIVC)的治疗方法、适应症、临床价值和注意事项。方法 自 1 986年 5月至 1 998年 6月我们完成了 APPC治疗下腔静脉 (IVC) -肝静脉 (HV)狭窄 39例和自体心包管代血管IVC移植 (VTIVC)治疗 IVC闭塞或缺损 3例 ,同时施行直视根治术切除梗阻病灶。结果 手术死亡 2例 (死亡率 4 .76 % ) ,1例死于肝肾综合征 ,另 1例死于呼吸道出血性窒息。 4 0例痊愈出院 (治愈率 95 .2 4 % )。术后随访 1 3～ 96个月 ,37例典型症状体征消失 ,B超和 IVC造影证实 IVC- HV通畅良好者 37例 ,术后 1 .5年显示 IVC狭窄 1例 ,2例于术后 2～ 4个月发现 IVC血栓形成。结论 APPC是治疗 IVC- HV狭窄或闭塞的直接有效的外科疗法 。

Objective To study the therapeutic methods,indication,clinic value and attentive item by the autologous pericardial patch cavoplasty (APPC) or reconstruction of the inferior vena cava(RIVC). Methods From May 1986 to June 1998,we have performed autologous pericardial patch cavoplasty (APPC) for inferior vena cava (IVC) and major hepatic vein (MHV or HV) stenosis in 39 patients,and vasotransplantation of the IVC by autologous pericardial canal for inferior vena caval occlusion or defect in 3 cases. In all patients, we underwent radial operation through right thoracic cavotomy under direct vision in room temperature and applied blockage of blood folw or shunt of inferior vena caval balloon catheter and APPC. We performed simultaneously removal of obstructive foci.Results Among the operative 42 patients, 2 cases early postoperative deaths (the operative mortality rate was 4.76 percent), one case died of hepatorenal syndrome and the other died of respiratory tract hemorrhagic asphyxia. The other 40 patients (95.24 percent) were discharged in a good conditon with 13 to 96 months follow up postoperatively. The 37 patients whose typical symptoms and signs were disappeared,B mode ultrasonography and cavography showed a good patency of the IVC and HV in the 37 cases, and showed that of inferior vena caval stenosis in one patient in the 18th postoperative months and thrombogenesis of the IVC in 2 cases in from and to 4th postoperative moths after RIVC.Conclusion We submit that RIVC are the best effective direct surgical therapy for IVC and HV stenosis or cclusion,and these patients recovered rapidly from illness,and they often get an obvious improved living quality and working quality.