经胸下腔静脉－右心房转流术治疗布－加氏综合征

在治疗布－加氏综合征诸多的手术中，经胸下腔静脉－右心房转流术是治疗肝静脉入口以上的下腔静脉梗阻所致的布－加氏综合征较为合理的术式。本组１８例均在下腔静脉梗阻的远侧切开膈肌，游离下腔静脉长４～５ｃｍ，周径的２／３，用Ｄａｃｒｏｎ血管行下腔静脉－右心房转流，效果良好。术中即见扩张之静脉塌陷，肝、脾缩小；术后腹水消失，足背静脉压下降，下肢水肿消失，小腿溃疡愈合。随诊１年２个月～１１年６个月，１８例均健在，从事正常工作和生活，无症状复发，转流血管通畅。隔肌切缘连续毯边式缝合，能明显减少胸水之产生，术后住院时间显著缩短，平均住院仅１５．４天。本手术的优点：手术安全，游离范围小，手术时间短，恢复快，无并发症及死亡；转流血管短，平均７．８ｃｍ；转流血管不受肝脏压迫，术后不用抗凝治疗，长期通畅率高。

Transthoracic Cavoatrial Shunt Treated Budd-Chiari Syndrome

Budd-Chiari Syndrom is often caused by obstruction of the inferior vena cava (IVC).From April 1982 to April 1992,18 cases with obstruction of IVC,above hepatic vein,which were treated by transthoracic phrenohepatic IVC with atrium bypass in our hospital.The elec-tive criteria of this group are as follow:(1) The obstruction of the IVC above the opening of hepatic veins with patent hepatic veins.(2)The stenosis of the IVC at the level of diaphragm.The postoperation produce pleura effusion,and continued for quite long time,After 1988,the cut edges of diaphragm were sutured lockstich in 10 cases,then the effusion reduced obviously, and in hosnital were remarkably short(average 15.4 days).Follow-up study from 9 months to 131 months(mean 53 months).All patients returned to normal work showed that the results were excellent.Advantage of this operation is safe,without complication and death.The dissective limit is less.Operative time is short,and these patients recover quickly.The cavoatrial grafts are short(average 7.9cm),and does not need anticoagulation,but their patency rate is high.