肝段下腔静脉全程显露的布加综合征根治术

目的总结肝段下腔静脉全程显露布加综合征根治术的治疗经验。方法回顾性分析了2001年9月~2006年10月在我科行肝段下腔静脉全程显露布加综合征根治术的60例患者的临床资料。结果所有患者均成功地在直视下完全切除病变,其中3例在体外循环辅助下完成,52例采用右房插管法,4例采用细胞回收机,1例采用自家回收血完成,回收血为300~4000ml。14例需输血400~2000ml,其余病例未予输血。1例于围手术期死于肾功能衰竭;1例下腔静脉血栓术后症状复发为新生隔膜,再次根治成功;1例术后下腔静脉再狭窄,无症状未予处理;其余病例术后症状体征消退。结论肝段下腔静脉全程显露布加综合征根治术视野更清晰,能更彻底地切除病变。

Radical surgery for Budd-Chiari syndrome through exposure of the whole hepatic segment of inferior vena cava

Objective To summarize the preliminary experience of a new type of radical treatment of Budd-Chiari syndrom under genuine direct vision. Methods We retrospectively analyzed the clinical data of 60 patients who were treated with radical exposing the whole inferior vena cava of hepatic segment in our hospital from September 2001 to October 2006. Results All lesions were completely resected under direct vision. Among all the patients, 3 were performed under extracorporeal circulation, 52 under catheterization of right atrium, 4 under cell saver, 1 under auto-retrieving of blood. The retrieved blood was from 300 to 4 000 ml. The transfusion of banked blood was from 400 to 2 000 ml for 14 patients, and no transfusion of banked blood were required for other patients. One patient died of renal failure during peri-operative period. The new-formed inferior vena cava(IVC) membrane was found in one relapsed patient whose IVC thrombosis removed one year ago. Asymptomatic restenosis of IVC was found in one patient after operation. Symptoms and signs disappeared in other patients after operations. Conclusion The new radical resection provides clearer visual field during operation and thus facilitates the resection of injuries.