布-加综合征手术前后血流动力学变化的临床研究

目的探讨布-加综合征（Budd-Chiari syndrome，B-CS）手术前后血流动力学变化规律。方法应用彩色超声多普勒对76例B—CS患者肝静脉变化情况、手术前后下腔静脉和门静脉主干内经或血流量进行了检测，同时在求中测量了下腔静脉压力和自由门静脉压力（free portal pressure，FPP）的变化。结果1a型21例，1b型6例，Ⅱ型23例，Ⅲa型17例，Ⅲb型9例。62例主肝静脉病变，副肝静脉（肝右后下静脉等）和（或）尾叶静脉扩张30例，肝内出现肝静脉交通支47例。肝后段下腔静脉病变53例。介入治疗23倒，根治性病变隔膜切除＋血栓取出术5例，下腔静脉转流术16例（包括腔-腔和腔-房人工血管架桥术），门腔分流术28例（肠-腔、脾-腔和脾-房人工血管架桥术），脾-肺固定术4例。介入和下腔静脉转流术后下腔静脉内径变窄和压力明显下降（P均〈0.05）；分流术后FPP降低（P〈0.05）。术后门静脉主干内径缩小（p〈0.05），平均流量和术前相比无明显变化（P〉0.05）。术中开放人工血管后短时间内（30分钟）可见肝脏从边缘开始质地变软，颜色由暗转红。近期随访（出院前）下腔静脉通畅，其远端扩张缓解，人工血管通畅。16例上消化道出血或食管静脉重度曲张患者进行胃镜复查，12例曲张程度减轻，4例消失。结论B-CS表现有特征性的血流动力学变化，根据其特点结合病变类型，可指导临床进行治疗方法的选择和预测（评估）治疗效果。

Clinical studies of hemodynamic changes before and after the Budd-Chiari syndrome surgery

Objective To study the law of the hemodynamic changes of preoperative and postoperative Budd-Chiari syndrome（B-CS）.Methods Seventy-six cases of B-CS underwent Color Doppler Ultrasonography preoperatively and postoperatively to detect the hepatic vein changes,the inner diameter and the blood flow of the inferior vena cava（IVC） and the main portal vein.The changes of IVC pressure and the free portal pressure（FPP） in the surgery were measure d at the same time.Results Twenty-one cases was diagnosed in Type Ia;6 cases in type Ib;23 cases in type Ⅱ;17 cases in type IIIa;9 cases in type IIIb.The lesion involved in main hepatic vein in 62 cases,and the vice-hepatic vein（the posterior right hepatic vein,etc.） and（or） the caudate lobe veins expansion in 30 cases,the hepatic vein communicating branch intrahepatic in 47 cases,the posterior hepatic segment of the inferior vena cava lesion in 53 cases.Twenty-three cases received intervention treatment,and radical resection of membrane and thrombus in 5 cases,IVC bypass（16 cases,including the cavocaval transflow and the cavoatrial transflow）,portacaval shunt（28 cases,including the mesocaval shunt,the splenocaval shunt and the splenoatrial shunt）,splenopneumopexy（4 cases）.The inner diameter changed narrowly and the pressure decreased significantly of IVC after the intervention and the veno-venous bypass surgery（P〈0.05）;the FPP was reduced after shunt（P〈0.05）;the inner diameter of main potral vein was changed narrowly postoperative（P〈0.05）,the average flow had no significant changes compared with preoperative（P〉0.05）;the texture of the liver began to soften and the color began from dark to red after the short time of opening of artificial blood vessel in surgery（30 minutes）.Recent follow-up（prior to discharge） showed that the IVC patency,distal expansion ease and the artificial blood vessel patency.16 cases of upper gastrointestinal bleeding or severe esophageal varicose veins with gastroscopy review showed that?