疑难重症或介入后复发布-加综合征的治疗

目的 探讨疑难、重症和介入后复发布-加综合征的治疗方法.方法 2004年2月至2007年8月间对28例疑难重症或复发的布加综合征患者进行了治疗,其中有经皮球囊扩张或支架植入术后复发者16例、手术后复发2例和疑难重症10例.治疗方法包括:肠腔房转流术10例,肠腔颈内静脉转流6例(1例采用了水母头),腔房或腔颈转流3例,肠腔转流2例,根治或扩大型根治术7例.结果 手术死亡1例(3.6%).人工血管感染1例(3.6%).随访中疗效优、良、中、差和死亡者分别为22.2%、55.5%、14.8%、3.7%和3.7%,满意者占92.5%.结论 根据不同病情施以积极个体化治疗,为疑难、重症和复发的布加综合征患者带来了希望.

Management of difficult, severe and recurrent Budd-Chiari syndrome

Objective To investigate the management of complicated, severe or recurrent Budd-Chiari syndrome. Methods From February 2004 to August 2007, 28 patients with complicated, severe or recurrent Budd-Chiari syndrome were treated. In this series, 16 patients relapsed after treated with percutaneous transluminal angioplasty or stent deployment, 2 cases relapsed after surgery; and the other 10 were under severe conditions and hard to treat, including malignancy of the inferior vena cava and right atrium. Mesocavoatrial shunt was carried out in 10 cases, mesocavojugular shunt in 6 (capitus medusa was used in one case), cavoatrial shunt in 2 and cavojugular shunt in 1, mesocaval shunt in 2, and radical or extended radical correction in 7. Results One patient ( 3.6% ) died in 24 hours after operation. Graft infection occurred in 1 case. Excellent, good, fair, poor and death rate were 22.2%, 55.5%, 14. 8%, 3.7% and 3.7%, respectively, the overall effective rate was 92. 5%. Conclusion To select personalized treatment according to the disease status brings hopes to difficult, severe, recurrent Budd-Chiari syndrome.