非体外循环下改良全腔静脉-肺动脉连接术

目的：探讨非体外循环下行改良全腔静脉－肺动脉连接手术治疗功能性单心室技术。方法：3例功能性单心室病儿在非体外循环下施行了改良全腔静脉－肺动脉连接手术。术中先作上、下腔静脉插管并与右房插管连接，静脉血分流入右房，然后置右肺动脉侧壁钳，上腔静脉远心端与右肺动脉上缘行端侧吻合，吻合口尽量偏左；下腔静脉通过心外管道与右肺动脉下缘连接，吻合口尽量偏右。最后缝扎肺动脉口。结果：术后无早、晚期死亡，仅1例发生低心输出量综合征及胸腔渗出。动脉血氧饱和度0．94－0．97。术后随访1－3个月，心功能I级2例，Ⅱ级1例。结论：非体外循环下行改良全腔静脉－肺动脉连接术，是治疗功能性单心室的有效技术，可取得良好的手术效果。     

下腔静脉与肝静脉的外科应用解剖

在３２例成人尸体上进行腔静脉与肝静脉的应用解剖学的研究，观测了右肾上腺静脉、左膈下静脉、主肝静脉的长度、横径、注入角度和部位及主肝静脉的汇合类型和下腔静脉各段长度。结果表明，术中阻断肝上膈下下腔静脉，有８４．４％的人可经腹部切口完成，另１５．６％者可能需开胸在心包内阻断下腔静脉，下腔静脉下阻断，有８７．５％可在网膜孔后分离阻断，１２．５％需行下腔静脉肝后段分离阻断。在游离肝右叶时，需注意可能出现的     

外伤性肝静脉损伤四例

男，27岁。车祸伤及右上腹部20min入院。查体：休克状态，腹膜刺激征明显。腹腔穿刺抽出大量不凝鲜血。术中诊断肝右叶损伤伴肝右静脉、腔静脉损伤，行不规则性右肝部分切除、腔静脉修补、肝右静脉缝扎术。术后死于失血性休克。     

肠系膜上静脉-下腔静脉-下腔静脉人工血管"Y"型架桥术治疗混合型布-加综合征32例分析

下腔静脉-右心房转流术(腔-房转流术)是治疗节段闭塞型布-加综合征(Budd-Chiari syndrome,B-CS)的常用方法,适用于肝后下腔静脉近右房处闭塞式狭窄、病变超过1 cm、至少有一支肝静脉(包括增粗的肝右后静脉)开口于阻塞段下方的下腔静脉并血流通畅的患者.     

延伸至右侧心腔的静脉内平滑肌瘤2例

例 1　女 ,37岁。 1年前因子宫肌瘤行子宫切除术。心悸、气短伴双下肢水肿 3个月。超声检查发现右房、右室及肺动脉内有团块状阴影。于 1997年 8月手术 ,术中见右房内有一来自下腔静脉、直径 2 8ｃｍ灰白色球形肿物 ,远端向右室及肺动脉延伸 ,形成直径 1ｃｍ ,长 18ｃｍ条状肿物 ,末端因伸至左、右肺动脉成为分叉状。在下腔静脉及右心房交界处切断并取出心内肿物。因病人一般情况差 ,未做剖腹手术。术后近期症状消失。 1999年 9月 ,因肝大肋下 2指 ,双下肢严重可凹性水肿再次入院。经超声、核磁共振、下腔静脉造影发现 ,三尖瓣关闭不全 ,右…     

肝及肝段下腔静脉联合切除后用自体静脉移植替代下腔静脉

应用现代外科和麻醉技术,可安全地施行75%以上肝的切除。但肝脏恶性肿瘤一旦侵犯肝段下腔静脉,通常放弃手术切除。作者报道一例肝右叶、尾状叶和肝段下腔静脉整块切除,并首次以自体股浅静脉移植替代下腔静脉。患者女性,34岁,右肾上腺癌行肾上腺切除术后 3年复发,CT显示肿瘤侵及肝右叶和尾状叶左、右段,包绕并压迫下腔静脉。腔静脉造影提示肿瘤水平肝段下腔静脉局部狭窄。术中解剖出肾上部和肝上部下腔静脉,切断右侧肝动脉、门静脉、肝管和肝静脉、     

联合腔肠房人工血管转流术治疗布加综合征14例体会

目的：探讨联合腔肠房人工血管转流术在中青年患者因下腔静脉血栓形成致下腔静脉和肝静脉回流障碍型布加综合征的应用。方法：本组14例，平均年龄28．6岁，均为肝段或长段下腔静脉血栓形成致肝静脉出口阻塞，其中12例下腔静脉完全阻塞，2例为肝段下腔静脉严重狭窄，采用3种腔肠房人工血管转流术，分别应用11例，1例和2例。结果：围手术期无死亡，随访时间4－52个月，平均24个月。方法：（1）术后2例人工血管因栓形成，1例最后改行腹膜腔颈内静脉腹水转流术；另1例并发上消化道出血，肝昏迷死亡。随访期死亡率为7％，总人工血管通畅率为86％，而腔房人工血管的通畅率为93％，本组患者门静脉压力下降范围为5－26cmH2O，平均下降15．5cmH2O，无其他严重并发症。结论：对于下腔静脉长段血栓致下腔静脉和肝脉回流障碍的中青年患者，联合腔肠房人工血管转流术不失为一种能同时缓解门脉和下腔静脉高压的手术方法，其远期通畅率尚有待于进一步评价。     

心房内管道行全腔静脉—肺动脉连接术

自１９９０年１月至１９９５年１月共施行全腔静脉－肺动脉连接术３２例，其中单心室２例，三尖瓣闭锁１例。应用心房内管道行全腔静脉－肺动脉连接术。该手术方法常规将上腔静脉远心端与右肺动脉行端侧吻合，然后选用直径〉１．５ｃｍ人工血管，将下腔静脉与主肺动脉吻合，方法简便，易于操作。其优点是：右房组织损伤小；血流动力学合理；更适用于伴共同心房和共同房室瓣等复杂畸形；选用直径１．５ｃｍ以上人工血管无需再更换；术     

经腹肝上下腔与肝后下腔静脉人工血管架桥术治疗Budd-Chiari综合征

目的:探讨治疗Budd-chiari综合征有效的手术方式。方法:肝后下腔静脉短节段闭塞型Budd-chiari综合征,16例采用经腹行肝上下腔静脉与肝后下腔静脉人工血管架桥术(改良手术组),相同病理类型18例应用开胸行右心房与肝后下腔静脉人工血管架桥术(传统手术组),进行疗效对比研究。结果:改良手术组16例中,术中1例急性右心衰,15例术中经过顺利。人工血管长度6~8cm,随访6~55个月人工血管内无血栓形成。传统手术组18例中,术中急性心包填塞1例。术后发生胸腔积液3例,肺部感染与急性心包炎各1例。人工血管长度12~14cm。术后随访60个月,有3例分别于术后37、42、58个月出现人工血管内血栓。结论:经腹腔行肝上下腔静脉与肝后下腔静脉人工血管架桥术临床效果优于传统的开胸行下腔静脉右心房人工血管架桥术,该手术是治疗肝后下腔静脉短节段闭塞型Budd-chiari综合征安全有效的手术方式。     

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目的 探讨紧邻肝内外重要血管的肝血管瘤的安全切除。方法 回顾性分析1996～2003年手术切除的27例紧邻肝内外重要血管的肝血管瘤的临床资料。肝上下腔静脉、肝下下腔静脉、肝右静脉或肝中肝左静脉共干预置阻断带。使用多功能手术解剖器行刮吸法切除肿瘤。结果 27例肝血管瘤均安全切除。肝上下腔静脉、肝下下腔静脉、肝右静脉或肝中肝左静脉共干预置阻断带，成功完成下腔静脉裂口修补2例，肝中静脉修补3例，肝右静脉修补1例。结论 肝上、肝下下腔静脉和主肝静脉预置阻断带有利于复杂情况下的肝血管瘤的安全切除．     

Balloon Venoplasty for Liver Failure Due to Stenosis of the Left Hepatic Vein After Right Tri-Segmentectomy

A 41-year-old male patient with hepatitis B underwent right tri-segmentectomy and total caudate lobectomy for a huge hepatocellular carcinoma associated with complete occlusion of the inferior vena cava with thrombosis of the infrahepatic inferior vena cava due to tumor compression. Five months later, he was readmitted for ascites and hyperbilirubinemia. Venography revealed stenosis and tortuosity of the left hepatic vein and the inferior vena cava, for which balloon angioplasty of the left hepatic vein and the inferior vena cava was performed using an 8-mm and 10-mm balloon, respectively. The left hepatic venous pressure decreased from 65 mmHg to 25 mmHg after dilatation. The patient made a satisfactory recovery thereafter and remains well with normal liver functions and without ascites. Balloon angioplasty may be useful for liver failure due to hepatic vein stenosis after hepatic resection.     

肝移植治疗晚期肝硬化

目的 肝移植治疗肝脏终末期病变。方法 采用改良的背驮式肝移植技术即保留肝后下腔静脉的全病肝切除,将供肝植于受肝原位,供、受体肝上下腔静脉,供、受体门静脉,供、受肝动脉行对端吻合;结扎供肝肝下下腔静脉。用ＦＫ５０６、晓翻和强的松三联免疫抑制剂抗排斥反应,加强术后监护和感染的控制。结果 例１、例２目前分别存活１１个月、８个月余,生活自理,例３因术后并发急性肾功能衰竭死亡,存活１４d。结论 肝移植是治愈肝脏终末期病谱的可靠方法。     

下腔静脉膈上段解剖特征及毗邻关系的尸体研究

目的:明确腹腔镜手术中下腔静脉膈上段的解剖特点及毗邻关系。方法:2018年12月于南方医科大学基础医学院选取成人尸体、新鲜尸体各2例。对冰冻尸体进行解剖。沿双侧锁骨中线打开胸腔,翻开心包前壁,解剖分离上腔静脉、下腔静脉。沿腹正中线打开腹腔,翻左、右肝叶,显露肝后段下腔静脉、第二肝门,剖开腔静脉裂孔进入心包,观察下腔静脉...     

Living donor liver transplantation in the absence of inferior vena cava: a case report

Because of difficulties in the supply of cadaveric organs, of living donor liver transplantations are performed in increasing numbers. Congenital hepatic fibrosis associated with fibrosis and atrophy of the inferior vena cava were present in a potential recipient of living donor liver transplantation. This case report documented living donor liver transplantation as a treatment modality for a patient with absence of the inferior vena cava due to chronic liver failure.     

Bedside carbon dioxide cavagrams for inferior vena cava filters: preliminary results

OBJECTIVE: The objective of this study was to evaluate the feasibility of using carbon dioxide (CO(2)) as a contrast agent in performing bedside inferior vena cavagrams before the insertion of vena cava filters. There was a consecutive series of patients undergoing bedside preinsertion cavagrams with inferior vena cava filter insertion. The setting was an 825-bed tertiary care hospital. The subjects were trauma patients undergoing inferior vena cava filter insertion. METHODS: The intervention used was vena cavagrams with CO(2) as the contrast agent. The main outcomes we measured were image quality, adverse reactions, cardiorespiratory changes, and renal failure. RESULTS: Ten patients underwent CO(2) cavography. All cavagrams were successful, demonstrating opacification of the inferior vena cava with identification of the renal veins and iliac bifurcation. There were no adverse reactions of renal failure. CONCLUSIONS: Carbon dioxide-contrasted vena cavagrams can be safely performed at the bedside, and they give good opacification of the inferior vena cava.     

背驮式肝移植的技术改进(附一例报告)

目的 探讨更完善的背驮式肝移植术式。方法 保留受者的腔静脉、肝静脉全部结扎,在受者的下腔静脉上开一侧孔,将供肝腔静脉近端与受者的下腔静脉侧孔行端侧吻合,远端缝扎。术中测定受者各时相的血流动力学参数。结果 无肝期为５０例,整个手术历时８小时,术中失血２５００ｍｌ。术中血流动力学平稳。术后肝功能指标大部分恢复正常,胆汁引流量约２００ｍｌ／ｄ。术后第５８天因肾功能衰竭死亡。结论 本术式适合于良性终末期肝     

原位肝移植术后下腔静脉狭窄的原因及防治

目的 探讨肝移植术后下腔静脉狭窄的原因和防治方法。方法 本组共施行原位肝移植术8例,通过彩超及下腔静脉造影检查证实术后发生下腔静脉狭窄2例。结果 在2例下腔静脉狭窄中,1例经球囊扩张及支架置入术而治愈;另1例病人拒绝手术自动出院。结论 肝移植术后下腔静脉狭窄的重要因素是吻合技术不当,肝脏体积过大,血肿形成,腹水生成,癌肿复发。球囊扩张、支架置入是有效的治疗手段。     

Radical surgery for Budd-Chiari syndrome. Direct excision and repair for obstruction of the vena cava (Budd-Chiari syndrome) under hepatic vascular exclusion using a centrifugal pump.

OBJECTIVE: To attempt to reduce the incidence of hepatic and cardiac failure after radical surgery for the Budd-Chiari syndrome. DESIGN: Retrospective case study. SETTING: University hospital, Japan SUBJECTS: Three patients with obstruction of the vena cava (Budd-Chiari syndrome) by a thick membrane, thrombus, and a long stenosis, respectively. INTERVENTION: Direct excision and repair by patch dilatation under hepatic vascular exclusion using a Biomedicus centrifugal pump. RESULTS: Hepatic vascular exclusion provides good visibility and enables accurate assessment of the obstruction, proper treatment, and relatively little blood loss. There were no complications, particularly liver failure or heart failure, and the inferior vena cava stayed patent in all cases. Liver function was improved in all three patients. CONCLUSION: This technique is safe and reliable for removal of obstruction of the inferior vena cava (Budd-Chiari syndrome).     

Pathology of the inferior vena cava and liver transplantation

Pathology of the inferior vena cava is not frequently encountered in the context of liver transplantation. Such a pathology was observed in 7.9% of our recipients, in the pre- intra- and post-operative period. Pre-existing anomalies of the IVC consisted the absence of the retrohepatic vena cava in 7 children with biliary atresia; technical adjustments were quite simple. During the operative period, dissection of the supra-hepatic vena cava was made very difficult in 2 patients with hepatic alveolar echinococcosis complicated by secondary biliary cirrhosis it was necessary to make a trans-diaphragmatic approach to the inferior vena cava. Post-operative inferior vena cava thrombosis occurred in four recipients, in three cases, it was caused by the inadequate size of the graft and major anastomotic discrepancy between the inferior vena cava of donor and recipient and in one case IVC thrombosis occurred in a context of allergy to heparin. Six of the 13 recipients with pathology of inferior vena cava died directly of indirectly because of these problems. Analysis of the causes of this pathology and their possible correction will perhaps allow better results in these patients who undergo liver transplantation.     

Surgical treatment of Budd-Chiari syndrome associated with superior vena cava obstruction; report of a case

We report a case of a 37-year-old woman with Budd-Chiari syndrome who underwent a radical treatment. She had had ascites, general edema, and liver dysfunction for 5 years. Preoperative cineangiogram showed a membranous stenosis at the retrohepatic inferior vena cava and the catheter could not be advanced into superior vena cava. In the operation, obstructed superior vena cava was identified. Membranous tissue at retrohepatic inferior vena cava was removed, and patch cavoplasty was performed under circulatory arrest through Senning procedure. Postoperative cavogram revealed good patency of inferior vena cava and her symptoms were disappeared.