腹膜后肿瘤术中腹主动脉及下腔静脉的切除与重建

目的 探讨累及腹主动脉及下腔静脉的腹膜后肿瘤切除时，受累血管的切除与重建的最佳方法。方法回顾性总结1990年1月至2003年6月33例累及腹主动脉及下腔静脉的腹膜后肿瘤的手术切除及血管重建的临床资料。结果全部病人均成功实施了肿瘤完整切除，包括受累血管的切除与重建，无手术死亡。随访29例，其3、5年存活率分别为60，1％和40．6％，平均存活期为53．9个月。结论累及腹主动脉及下腔静脉的腹膜后肿瘤不是根治性切除的手术禁忌证，腹主动脉及下腔静脉的切除与重建术，安全、有效、可行；重建腹主动脉及下腔静脉可以提高肿瘤的切除率，降低局部复发率，延长病人存活时间。     

累及下腔静脉的腹膜后肿瘤的外科处理(附14例报告)

目的:探讨累及下腔静脉的腹膜后肿瘤切除时,联合下腔静脉切除和重建的处理方法.方法:同顾分析2003年1月至2007年10月收治的14例累及下腔静脉的腹膜后肿瘤的手术切除及下腔静脉重建的临床资料.结果:所有病人均成功实施肿瘤的完整切除,腔静脉的重建方法包括:下腔静脉侧壁部分切除,单纯修补7例:部分腔静脉切除(＜2 cm)端端吻合4例;部分腔静脉切除,人工血管重建3例.本组无手术死亡.随访12例,平均生存时间(38.6±5.8)个月.结论:术前B超、CT、MRI及血管造影等影像学检查至关重要.下腔静脉受累并非手术的禁忌.为减少腹膜后肿瘤术后复发和提高生存率,联合下腔静脉切除和重建是安全、有效和可行的.     

侵及胸廓上口大血管的纵隔肿瘤的外科治疗

目的　探讨侵及胸廓上口大血管的纵隔肿瘤的外科治疗经验。方法　回顾分析 11例侵及胸廓上口大血管的纵隔肿瘤患者的临床资料 ,全组患者均行纵隔肿瘤切除 ,其中 2例于麻醉诱导前辅以股 -股转流并行体外循环 ,2例辅以颈静脉、股静脉 -股动脉转流并行体外循环。同期行上腔静脉重建 2例 ,成形 2例 ,左无名静脉成形 3例 ,右无名静脉成形 1例 ,无名动脉、左颈总动脉、左锁骨下动脉人造血管置换各 1例。结果　全组病例无手术死亡。术后随访 2～ 7年 ,3例于 2～ 4年后死于癌瘤复发 ,6例无瘤健康生存 ,均未出现血管栓塞。结论　侵及胸廓上口的大血管纵隔肿瘤宜积极手术治疗 ,麻醉诱导前辅以股 -股转流或颈、股 -股转流。同期作血管成形或重建。术后小剂量抗凝治疗     

腹膜后肿瘤联合血管切除重建29例临床应用

目的探讨联合血管切除重建治疗腹膜后肿瘤的必要性和合理性。方法回顾性分析自2000年1月至2010年2月收治的29例侵及血管的腹膜后肿瘤病例,其中男20例,女9例,年龄10～76岁,平均年龄52岁。检查结果显示肿瘤侵润、包绕重要血管19例,肿瘤与重要血管关系密切、推移10例。所有病例均行肿块完整切除联合血管重建。结果本组无围手术期死亡,获随访24例。随访时间8～89个月,平均随访5.2年。2例下腔静脉及4例髂静脉分别于手术后3～9个月发生血栓,未出现明显肢体肿胀。无人工血管感染病例,1年生存率为100%,1～5年死亡12例,存活5年以上10例,其中3例肿瘤复发再次手术。其余病例尚在随访中。结论对于腹膜后肿瘤侵犯周围血管,术中难以分离的病例,联合血管切除重建增加了切除率,提高了存活率。     

下腔静脉平滑肌肉瘤的诊断及外科治疗

目的 了解下腔静脉平滑肌肉瘤的临床特点，总结下腔静脉平滑肌肉瘤的诊治经验。方法 对1986—2006年中国人民解放军总医院普外科收治的14例下腔静脉平滑肌肉瘤病人的临床资料进行回顾性分析。结果 12例病人实施手术，其中11例行肿瘤及相应的下腔静脉切除和必要的下腔静脉重建，1例仅行剖腹探查肿瘤活检；2例因远处转移而未手术。结论 肿瘤整块切除及必要的下腔静脉重建是治疗下腔静脉平滑肌肉瘤的有效方法。     

累及下腔静脉的腹膜后肿瘤手术处理经验

目的探讨累及下腔静脉的腹膜后肿瘤手术时下腔静脉的处理方法 ,以提高切除率及手术安全性。方法回顾性分析 1990年 1月至 2 0 0 3年 4月收治的 4 1例腹膜后肿瘤累及下腔静脉的手术切除及血管重建的临床资料。结果 4 1例累及下腔静脉的腹膜后肿瘤的手术方式有 :下腔静脉部分切除、修补术 17例 ;部分下腔静脉并右肾切除术 11例 ;部分下腔静脉切除、残端结扎术 10例 ,其中 3例行人工血管植入术。结论B超、CT、MRI是术前必不可少的检查 ,选择性血管造影可以明确下腔静脉受压、移位、畸形及有无闭塞。累及下腔静脉并非腹膜后肿瘤行根治性切除的手术禁忌证 ,下腔静脉部分切除与重建安全、有效、可行 ,可以大大提高肿瘤的切除率、降低复发率。     

肿瘤侵及胸腹部大血管的外科治疗

目的 总结侵及胸、腹部大血管的肿瘤治疗过程中血管外科技术的临床应用及其疗效。方法2001年1月至2005年12月，23例病人因肿瘤侵及胸、腹部大血管而行血管成形或重建术。结果行肿物根治性切除19例，切除率达82．6％；行姑息性切除术4例，切除率17．4％。全组无术中死亡，围术期并发症发生7例次，发生率30．4％。全组随访20例（86．9％），失访3例，最长随访63个月。围术期死亡4例，病死率17．4％。截至2005年8月，全组术后生存40d～59个月，生存48个月以上3例，36个月以上4例，24个月以上6例，12个月以上9例，6个月以上12例；通过影像学检查手段了解移植血管通畅程度、肿瘤复发和转移情况，2例人工血管血栓形成，其余病例均无并发症。结论病例选择恰当，尽量行肿瘤根治性切除并进行大血管重建，可提高病人生存率和生活质量。     

累及下腔静脉的原发性腹膜后肿瘤的外科治疗

腹膜后肿瘤包括原发性和继发性两类,原发性腹膜后肿瘤(primary retroperitoneal tumor,PBT)是指来源于腹膜后间隙和大血管的非器官性肿瘤.肿瘤侵及腹膜后大血管是手术彻底切除的主要障碍.手术能否根治性切除,取决于对被侵及血管的处理[1].我们于2000年9月至2005年4月收治腹膜后肿瘤累及下腔静脉(inferior vena cava,IVC)患者13例,现报告如下.     

血管重建在原发性纵隔肿瘤中的临床应用

目的总结血管重建在原发性纵隔肿瘤中的应用经验和疗效。方法经外科手术治疗并血管重建的原发性纵隔肿瘤76例,22例（28.9%）单纯侵及上腔静脉;16例（21.1%）侵及单纯左或右无名静脉;34例（44.7%）侵及上腔静脉和左或右无名静脉;有4例（5.3%）单纯侵及主动脉外膜。行完整切除70例,部分切除6例;行血管置换46例,血管成形30例。结果全组病人无一例围术期死亡。上腔静脉阻断时间为（10-30）min,平均（18.0±5.3）min。左或右无名静脉单侧阻断时间为（11-25）min,平均（16.5±4.2）min。全组病人均获随访,时间为12-26个月,术后生活质量满意。结论纵隔肿瘤侵及上腔静脉及其属支大血管的病人,如全身无系统功能严重受损应积极手术治疗,可选用血管置换或血管成形术。     

肿瘤侵犯上腔静脉的外科治疗

目的探讨上腔静脉综合征(SVCS)的手术方法,总结外科诊治经验。方法 2008年10月至2014年7月福建医科大学附属协和医院胸外科采用全上腔静脉人造血管置换或心包补片修补成形术成功治疗恶性肿瘤侵犯上腔静脉导致的SVCS患者11例,其中恶性纵隔肿瘤8例,淋巴瘤2例,肺癌1例。9例患者采用全上腔静脉人造血管置换;2例患者行上腔静脉部分切除,自体心包补片重建术。结果全组无手术死亡病例,术后患者上腔静脉梗阻症状均明显改善。全组患者术后随访8~68个月,除1例肺癌患者存活18个月后死于肿瘤复发转移,其余10例患者均无肿瘤复发,生活质量良好,术后生存时间为8个月至5年。结论采用手术扩大切除肿瘤及受侵的上腔静脉系统并行血管重建,能在短期内显著缓解SVCS的临床症状,提高生存质量,效果确切。     

累及髂血管的原发性腹膜后肿瘤的外科治疗

目的探讨累及髂血管的原发性腹膜后肿瘤的外科治疗。方法回顾性分析笔者所在医院血管中心2006年12月至2011年12月期间收治的124例累及髂血管的腹膜后肿瘤行外科治疗患者的临床资料,其中男68例,女56例;年龄16～72岁,平均年龄44岁。结果所有患者均行手术治疗,术中探查见肿瘤压迫和挤压髂血管72例,浸润血管或包绕髂血管52例。肿瘤完全切除90例,肿瘤不完全切除31例,肿瘤姑息性切除3例;其中有42例患者同时行髂血管一并切除和髂血管重建。本组患者无围手术期死亡。1例患者术后第3天出现尿瘘,经充分引流后自行愈合;1例患者出现切口脂肪液化,经更换敷料后切口愈合良好;其余患者均未出现并发症。本组患者均获随访,随访时间12～24个月,平均16个月。随访期间有12例患者死亡。90例肿瘤完全切除患者,随访期间局部复发38例,复发率为42.2%;31例肿瘤不完全切除患者,有9例死亡（6例死于肿瘤复发,3例死于心脑血管意外）,3例行姑息性肿瘤切除者在随访期间全部死亡（3例均死于肿瘤复发）。42例行髂血管一并切除和髂血管重建者,随访期间有3例出现局部复发但未再累及血管;1例患者术后7个月肿瘤复发累及下腔静脉,造成下腔静脉闭塞及双下肢静脉血栓形成;2例患者术后个8月后肿瘤复发再次累及髂总静脉,1例患者左髂总静脉移植术后10个月移植物血栓形成。结论累及髂血管的原发性腹膜后肿瘤联合血管修复重建可明显提高肿瘤切除率,降低复发率,提高远期存活率。     

Resection of the inferior vena cava for neoplasms with or without prosthetic replacement: a 14-patient series

OBJECTIVE: To review the outcome of resection of the suprarenal or infrarenal inferior vena cava (IVC) and possible indications for prosthetic replacement. SUMMARY BACKGROUND DATA: Involvement of the IVC has long been considered a limiting factor for curative surgery for advanced tumors because the surgical risks are high and the long-term prognosis is poor. Prosthetic replacement of the IVC is controversial. METHODS: The authors retrospectively reviewed a 7-year series of 14 patients who underwent en bloc resection including a circumferential segment of the IVC. The tumor was malignant in 12 patients and benign in 2. The resected segment of the IVC was located above the kidneys in eight patients and below in six. Resection was performed without extracorporeal circulation in all patients. RESULTS: In all but one patient, IVC resection was associated with multivisceral resection, including extended nephrectomy (n = 8), major hepatic resection (n = 3), digestive resection (n = 3), and infrarenal aortic replacement (n = 2). Prosthetic replacement of the IVC was performed in eight patients cases and was more common after resection of a suprarenal (6/8) than an infrarenal segment of the IVC (2/6). One patient died of multiorgan failure. Major complications occurred in 29% of patients. Symptomatic complications of prosthetic replacement occurred in one patient (acute postoperative thrombosis, successfully treated by surgical disobstruction). Graft-related infection was not observed. Marked symptoms of venous obstruction developed in three of the six patients who did not undergo venous replacement. In patients undergoing surgery for malignant disease, the estimated median survival was 37 months and the actuarial survival rate was 67% at 1 year. CONCLUSION: Multivisceral resection including a segment of IVC is justified to achieve complete extirpation in selected patients with extensive abdominal tumors. Prosthetic replacement of the IVC may be required, particularly in cases of suprarenal resection. It is a safe procedure with a low complication rate and good functional results.     

Left Renal Vein Graft for Vascular Reconstruction in Abdominal Malignancy

Background Advanced abdominal malignancies are occasionally invasive for the major blood vessels, such as the portal vein (PV), inferior vena cava (IVC), and major hepatic veins (HVs), and complete removal of the tumors is required for patients undergoing vascular resection and reconstruction. We used left renal vein (LRV) grafts for vascular reconstruction in patients with these malignancies and evaluated their clinical relevance. Methods A total of 113 patients underwent vascular resection including the PV (42 patients), IVC (68 patients), and HV (3 patients) for hepatobiliary-pancreatic or abdominal tumor resection. Of these, 11 patients underwent vascular reconstruction with a LRV graft of the PV, superior mesenteric vein (SMV), and HVs in 3 patients each, and the IVC in 2 patients. The HVs were resected with segmentectomy involving Couinaud’s segments VII, VIII, and IV; VII, VIII, and II; or III, IV, VIII in each patient. The PV and SMV were resected in 5 patients undergoing pancreaticoduodenectomy for pancreatic carcinoma, and in 1 patient being treated with extended right hepatectomy and pancreaticoduodenectomy for hepatic hilar carcinoma. The IVC was partially resected in 1 patient with advanced colon cancer and 1 with malignant schwannoma. Results The mean graft length of LRV obtained was 3.6 (3.5–4.0) cm. The graft was used as a tube in 9 patients, and as a patch in 2 patients. The mean duration of clamping time was 41.9 (35–60) min. Portal vein thrombosis was encountered in 2 patients, and anastomotic stenosis in 1 patient. Other morbidity was not related to vascular reconstruction. One patient who underwent extended right hepatectomy and pancreaticoduodenectomy died of liver failure in the hospital. The serum creatinine level after surgery did not deteriorate except in the one patient who died in the hospital. Graft patency was maintained during the follow-up period in all patients. Conclusions A LRV graft may enhance the possibility of vascular reconstruction without deteriorating serum creatinine level, and it provides sound graft patency.     

Surgical strategy for treating renal cell carcinoma with thrombus extending into the inferior vena cava

OBJECTIVE: A surgical strategy for treating malignant renal tumors with thrombus extending into the inferior vena cava (IVC) was assessed. METHODS: We retrospectively reviewed the records for all patients with renal cell carcinoma (RCC; n=30) or Wilms tumor (n=1) with tumor thrombus extending into the IVC who underwent surgical intervention at our institution between January 1980 and December 2001. Tumors were classified preoperatively according to the cephalad extension of thrombus, and intraoperative procedures were selected on the basis of degree of extension. Patients with RCC underwent radical nephrectomy and removal of thrombus with (n=11) or without (n=19) IVC resection. Partial normothermic cardiopulmonary bypass without cardiac arrest was used in 4 patients. The Pringle maneuver was performed in 8 patients. Infrarenal abdominal aortic cross-clamping was used in 8 patients to maintain systemic blood pressure. IVC cross-clamping and the Pringle maneuver were performed in 5 patients with suprahepatic thrombus extension. Temporary placement of a filter in the IVC or plication of the IVC above the hepatic vein was performed before hepatic mobilization, to decrease the risk for pulmonary embolism. RESULTS: One patient died intraoperatively of pulmonary embolism. Postoperative complications occurred in 11 patients; all resolved with conservative therapy. The postoperative duration of survival in patients with RCC was 37 +/- 44 months (range, 4-180 months); the 5-year survival rate was 42%. CONCLUSION: Aortic cross-clamping during IVC occlusion prevented hypotension and maintained hemodynamic stability that has required bypass in other series. This surgical treatment with the less extensive approach could result in long-term survival of patients with RCC in whom tumor thrombus extends into the IVC. We recommend that radical nephrectomy and tumor thrombectomy, with or without caval resection, be performed in these patients, with less invasive additional maneuvers.     

Hepatic resection with reconstruction of the inferior vena cava or hepatic venous confluence for metastatic liver tumor from colorectal cancer

BACKGROUND: Resection of colorectal liver metastases infiltrating the inferior vena cava (IVC) or hepatic venous confluence (HVC) is technically feasible, but the procedure frequently involves invasive techniques, and its long-term outcome has not yet been fully described. STUDY DESIGN: From October 1994 through June 2001, 87 patients underwent first curative hepatic resections for colorectal metastases. Nine patients (the IVC/HVC group) received hepatectomy combined with IVC or HVC reconstruction. Clinicopathologic characteristics, surgical results, and patient survival were investigated and compared with those of the remaining 78 patients (the comparison group). RESULTS: Three IVCs and eight hepatic veins were successfully resected and reconstructed by primary closure (n = 3), direct anastomosis (n = 1), or by the use of autologous vein grafts (n = 7). A comparison between the two groups revealed that the primary colorectal tumor stage was similar, but the IVC/HVC group had more (median 4 versus 2, p < 0.05) and larger (median 5.0 versus 3.2 cm, p < 0.05) lesions. The IVC/HVC group required longer operating times (median 600 versus 320 minutes, p < 0.001) and suffered greater blood loss (median 1,034 versus 434 g, p < 0.01) and more extensive liver parenchyma resection (median 585 versus 155 g, p < 0.001). Patients in the IVC/HVC group had a shorter survival time (median survival time 25.8 versus 44.0 months, p < 0.01). CONCLUSIONS: Hepatic resection combined with the IVC or HVC reconstruction for colorectal liver metastases can be performed with acceptable morbidity, and possibly with no mortality. Although no definite conclusion on long-term survival can be drawn from our study, given the limited number of patients, their overall survival was unsatisfactory. Further studies are needed to clarify the contribution of combined resection and reconstruction of IVC/HVC to long-term survival, because surgical resection currently provides the only hope of cure.     

Resection and reconstruction of the great vessels for lung cancer and mediastinal tumor

Between January 1994 and December 1997, 17 patients with lung cancer and 5 patients with mediastinal tumor underwent extensive resection and reconstruction of the great vessels. In patients with lung cancer, the aorta was resected under cardiopulmonary bypass in 4 patients, the superior vena cava in 12, and the left main pulmonary artery with combined resection of the left atrium in 1 and the aorta in 1. In five patients who underwent resection of the superior vena cava, subcarinal resection and reconstruction were also performed. Three patients died within 30 days after surgery. Six patients died of cancer between 3 months and 2 years after surgery. Two patients who underwent aortic resection for node negative lung cancer have survived more than 3 years after surgery. Six patients have survived between 6 months and 2 years after surgery. The histologic type of mediastinal tumor was thymic cancer in 3 patients, invasive thymoma in 1 and malignant lymphoma in 1. In patients who underwent resection of the superior vena cava for mediastinal tumor, bilateral brachiocephalic vein reconstruction was performed in 4 patients and the left brachiocephalic vein reconstruction in 1. One patient underwent resection of the right atrium. The patient with invasive thymoma has survived for more than 3 years. Two of 3 patients with thymic cancer died within 2 years. When complete resection is achieved with combined resection of the great vessels, survival may be anticipated in patients with N0 lung cancer or in those with invasive thymoma.     

Surgical treatment for colorectal liver metastases involving the paracaval portion of the caudate lobe

BACKGROUND: Hepatic neoplasms in the paracaval portion of the caudate lobe (S1r) are usually difficult to treat surgically because such neoplasms often invade the hepatic veins and/or inferior vena cava (IVC). We reevaluated resected cases of colorectal liver metastases involving S1r to confirm the significance of aggressive surgical treatments. METHODS: Between July 1977 and December 2002, 95 consecutive patients with colorectal liver metastases underwent hepatic resection. Seven patients with liver metastases involving the S1r underwent resection. RESULTS: The surgical procedures for liver metastases comprised 3 isolated caudate lobectomies, 2 right hepatectomies, and 2 right hepatic trisectionectomies with caudate lobectomy. Combined resections included partial resection of the hepatic vein in 2 patients, wedge resection of the IVC in 3, and segmental resection of the IVC in 1. Six of the 7 patients with S1r metastasis had recurrent disease in liver and/or lung. A second hepatectomy was carried out in 4 patients and a partial lung resection in 2 patients. Four of the 7 patients survived more than 5 years, but 2 of them died of recurrent disease at 61 and 95 months after initial hepatectomy. The remaining 2 patients are alive 72 and 118 months without any sign of recurrence. The median survival time of the 7 patients was 60 months. CONCLUSION: Liver metastases involving the S1r could be resected radically with en bloc resection of the major hepatic veins and/or the inferior vena cava. An aggressive surgical approach with combined resection of the adjacent major vessels may offer a better chance of long-term survival in selected patients with caudate lobe metastasis from colorectal cancer.     

Sequelae after limb-sparing surgery with major vascular resection for tumor of the lower extremity

PURPOSE: Limb-sparing procedures have recently replaced amputations as the treatment for tumors invading major vessels of the lower extremity. Major arteries must be reconstructed for limb salvage. The veins are not usually reconstructed. This study was undertaken to investigate the sequelae such as chronic venous disease after venous resection for tumors. METHODS: Ten patients who underwent limb-sparing surgery for a tumor of the lower extremity or retroperitoneum that required major vascular resection were studied. The median follow-up period was 48 months. After combined resection of a major artery and vein, arterial reconstruction was performed. The veins were not reconstructed. The resected veins included the inferior vena cava (n = 2), the external iliac and common femoral veins (n = 3), the superficial femoral vein (n = 3), and the popliteal vein (n = 2). The main outcome measures were clinical classification of chronic venous disease in 10 patients and air plethysmography in seven patients. RESULTS: Clinical classification was C(0A) in 6 patients, C(3A) in 1 patient, C(3S) in 2 patients, and C(4S) in 1 patient. Venous claudication with uncontrollable edema was observed in two patients with C(3S) disease. Pain and itching with inflammatory skin changes were observed in one patient with C(4S) disease. These three patients had undergone resection of the femoral vein, including the deep femoral vein along with proximal adductor muscles. Air plethysmography revealed that the ejection fraction was significantly lower and the residual volume fraction was significantly higher in the three patients with symptoms than in symptom-free patients. CONCLUSIONS: Significant chronic venous disease was observed in the patients who underwent combined resection of the femoral vein, the deep femoral vein, and the adductor muscles for a tumor.     

The Use of Autologous Peritoneum for Complete Caval Replacement Following Resection of Major Intra-abdominal Malignancies

Objective

Assessment of a simple layer peritoneal tube used as an autogenous inferior vena cava replacement.

Background

Extensive en-bloc multivisceral resection including major vessels is effective in selected abdominal malignancies, but the need for vascular reconstruction represents a surgical challenge. We describe the use of autologous peritoneum for caval replacement.

Methods

Autogenous parietal peritoneum without fascial backing was harvested and tubularized to replace the inferior vena cava (IVC) in four patients with complex abdominal tumors. Surgical morbidity was evaluated using the Clavien–Dindo classification, and graft patency was systematically evaluated with ultrasound.

Results

All four patients had multiorgan resections for malignancies involving the retro-hepatic IVC, and they all required the replacement of infrarenal and suprarenal IVC segments. Additionally, all four required a right nephrectomy, two had a combined major hepatectomy, and one patient needed a veno-venous bypass. All had an R0 resection. A clinical follow-up took place between 5 and 11 months after surgery for each patient. Four-month graft patency was confirmed by ultra-sound and TDM with no sign of disease recurrence.

Conclusions

Autologous peritoneum without fascial backing is a good and safe option for circumferential replacement of IVC after extensive en-bloc tumor resection with IVC involvement.

     

肠-腔-房转流术治疗混合型布加综合征的疗效分析

目的 探讨应用人工血管行肠-腔-房转流术(MCAS)治疗混合型布加综合征的临床效果.方法 回顾性分析2000年2月至2004年5月山东大学齐鲁医院收治的17例混合型布加综合征患者的临床资料.17例患者均为全部或两支肝静脉主干阻塞且肝后下腔静脉长段血栓形成或长段闭塞(或)狭窄,应用人工血管行MACS.观察并比较患者手术前后的临床症状、门静脉及下腔静脉压力;患者术后并发症发生率;人工血管通畅率.采用Kaplan-Meier法分析患者生存率,χ2检验和t检验分析相关数据.结果 全组患者无围手术期死亡.17例患者中15例临床症状消失或缓解,与术前比较,差异有统计学意义(χ2=9.78,P<0.05);3例出现并发症;门静脉及下腔静脉压力术后较术前平均下降1.2 cm H2O(1 cm H2O=0.098 kPa)和18.5 cm H2O,其差异有统计学意义(t=2.38,3.06,P<0.05);1、3、5年生存率分别为16/17、15/17、14/17;5年人工血管通畅率为14/17.结论 MCAS可同时缓解混合型布加综合征的门静脉高压和下腔静脉高压,术后降压效果明显,并发症少,5年生存率和人工血管通畅率高,是一种可供选择的手术方式.