Y型人工血管转流治疗混合型布加综合征患者的疗效分析

目的 探讨肠-腔-房Y型人工血管转流治疗混合性布加氏综合征患者的疗效.方法 对1990-2006年于河南省人民医院收治的51例混合性布加氏综合征患者实施了肠-腔-房Y型人工血管转流.先于肝前行人工血管(直径16～18 mm,主血管)与肾静脉以下下腔静脉和右心房的吻合,然后再行人工血管(直径10～12 mill,支血管)与肠系膜上静脉和主血管的吻合.监测手术前、后下腔静脉、门静脉压力及血流流速.结果 手术后即日胸腹壁浅静脉曲张消失,无住院期死亡病例.随访6个月至16年,随访期内主血管未发现血栓,通畅率100%,支血管血栓形成2例,通畅率为96.1%.术后下腔静脉压力较术前下降了17.4 cm H2O±5.7 cm H2O(1 cm H2O=0.098 kPa),门静脉压力下降了17.0 cm H20±7.0 cm H20.结论 Y型人工血管转流能同时有效地降低下腔静脉及门静脉压力并不增加术后并发症,是治疗混合性布加氏综合征较为理想的手术方式.

Treatment of Budd-Chiari syndrome with occlusion of both inferior vena cava and hepatic veins lesions by interposition of graft meso-caval-atrial shunt

Objective To evaluate the the therapeutic efficacy of interposition of graft meso-cavo-atrial shunt(MCAS)for the treatment of Budd-Chiari syndrome(BCS)with occlusion of both inferior cava vena (ICV)and hepatic veins(HVs).Methods 51 BCS patients with combined occlusion of ICV and HVs,30 males and 20 females,aged 18-45.underwent MCAS.A 16-18 mm ring-reinforced graft(main graft) was anastomesed firstly to the side of ICV with continuous 5/0 Vascular suture,then to the side of the right atrium with continuous 5/0 vascular suture.A 10-12 mm graft(secondary graft) Was anastomosed to the side of the superior mesenteric vein(SMV)with continuous 5/0 vascular suture,then to the side of the main graft with continuous 5/0 vascular suture.The pressure and blood flow of ICV and portal vein(PV)were examinedbefore and after operation.The patients were followed up for 6 months to 16 years.Results There Was no perioperative death.During the follow-up no thrombosis of the main graft Was found but thrombosis of the secondary graft occurred in two cases.The patency rates of the main and secondary grafts were 100%and 96.1%respectively.The total patency rate of graft was 96.1%.After operation the pressure of IVC and PV decreased by 17.4±5.7 cm H2O and 17.0±7.0 cm H2O respectively compared with those before operation.Conclusion MCAS is very effective in decompression of PC and IVC.MCAS may be a Valuable surgical procedure for treatment of BCS with occlusion of both ICV and HVs.