布-加综合征个体化治疗临床研究

目的探讨不同类型布-加综合征（B—CS）的个体化治疗方案。方法回顾性分析173例B—CS患者的·临床资料。结果根据彩超和64排CT血管成像，将其分为3种类型（5个亚型）。治疗方法包括：下腔静脉球囊扩张成形（或加支架置入）术59例，根治性病变隔膜切除和血栓取出术21例，下腔静脉旁路术（下腔静脉-下腔静脉架桥术7例，下腔静脉-右心房架桥术18例），肠系膜上静脉-下腔静脉架桥术36例，脾静脉-下腔静脉架桥术20例，脾静脉-右心房架桥术6例，改良脾-肺固定术6例，联合手术（下腔静脉球囊扩张＋肠-腔架桥术10例）。术后并发症发生率为10．4％（20／173），围术期病死率为2．31％。随访时间6个月～5年，122例总有效率为83．60％（102／122），术后1年和5年的复发率分别为7．76％（8／103）、12．5％（12／96）。结论布-加综合征治疗方法较多，应根据不同的病理类型、门静脉高压或下腔静脉高压的程度以及患者全身情况采取个体化治疗方案。

Clinical study on individual treatment of Budd - Chiari syndrome

Objective To study the individual treatment of different type of Budd - Chiari syn- drome （ B - CS）. Methods The clinical datas of 173 cases of B - CS treated by surgery were retrospectively analyzed. Results Based on color doppler ultrasonography and 64 Multislice CT, all patients with B - CS were classified into 3 types （5 subtypes）. Surgical treatment methods were as following： percutaneous transluminal angioplasty （PTA） and/or stenting of the inferior vena cava （IVC） in 59 cases, 21 cases were performed radical resection of membrance and thrombus, inferior vena cava bypass （ Among them, 7 cases and 18 cases were performed cavocaval shunt and cavoatrial shunt respectively）. Thirty - six cases were performed mesocaval shunt, 20 cases were performed splenocaval shunt. Six cases were performed splenoatrial shunt, 6 cases were performed splenopneumopexy, 10 cases were performed combined operation（ meso- caval shunt combined with PTA and stenting of the IVC）. Complication rate was 10.4% （20/173）, perioperation death rate was 2.31%. One hundred and twenty - two patients were followed - up for 6 months to 5 years. In 83.60% （102/122） of patients, the results were successful, but the recurrence rate was 7.76%, 12. 5% ,respectively at 1 and 5 year after the operation. Conclusions There are various treatments of B - CS, individual scheme should be advocated according to different clinicopathologic types,levels of inferior vena cava hypertension or portal hypertenion and general condition of the patients.