经腹Budd-Chiari综合征根治术4例诊治体会

目的: 探讨经腹Budd-Chiari综合征根治术疗效及注意事项。方法: 4例均行下腔静脉造影确定病变部位、类型后,经上腹"人"字型切口进腹,充分游离肝上、下段下腔静脉及病变,3例直视下切除隔膜并取栓,直接缝合;1例为双隔膜,切除隔膜并取栓后用直径25 mm球囊扩张,取e-PTFE人工血管补片扩大成型。结果: 4例手术均成功,无死亡及急性肺动脉栓塞发生,术后下腔静脉高压症状完全消失。随访6~14个月,1例术后6个月下腔静脉造影发现原病变处狭窄,行球囊扩张内支架后症状消失。结论: 经Budd-Chiari综合征根治术与传统根治术相比具有创伤小、术后并发症相对少等优点,是一种安全可靠的外科手术方式。

Radical surgery for 4 patients with Budd-Chiari syndrome through abdomen approach

Objective:To investigate effective surgical therapy and essentials on Budd-Chiari syndrome.Methods:The IVC venography was used to investigate the diseased segment,and the open surgical resection of abnormal segment in IVC was performed in 3 patients through an inverse Y incision on abdomen.The double membrane was found in one patient and the surgical resection and obliterans from IVC were performed,and the balloon dilatation and angioplasty with e-PTFE vascular graft were also performed.Results:All the operations were successful.There were no death and pulmonary embolus.The syndromes of IVC hypertension was alleviated completely.The following up ranged from 6 months to 14 months.The stritcture was found after 6 months in one patient,and the syndromes disapeared after the percutaneous transluminal angioplasty and endovascula stent was performed.Conclusions:Radical surgery on Budd-Chiari syndrome through abdomen approach was less invasive,safty with less complications.