CAJ | 학술논문

目的探讨应用人工血管行肠-腔-房转流术(MCAS)治疗混合型布加综合征的临床效果.方法回顾性分析2000年2月至2004年5月山东大学齐鲁医院收治的17例混合型布加综合征患者的临床资料.17例患者均为全部或两支肝静脉主干阻塞且肝后下腔静脉长段血栓形成或长段闭塞(或)狭窄,应用人工血管行MACS.观察并比较患者手术前后的临床症状、门静脉及下腔静脉压力;患者术后并发症发生率;人工血管通畅率.采用Kaplan-Meier法分析患者生存率,χ2检验和t检验分析相关数据.结果全组患者无围手术期死亡.17例患者中15例临床症状消失或缓解,与术前比较,差异有统计学意义(χ2=9.78,P<0.05);3例出现并发症;门静脉及下腔静脉压力术后较术前平均下降1.2 cm H2O(1 cm H2O=0.098 kPa)和18.5 cm H2O,其差异有统计学意义(t=2.38,3.06,P<0.05);1、3、5年生存率分别为16/17、15/17、14/17;5年人工血管通畅率为14/17.结论 MCAS可同时缓解混合型布加综合征的门静脉高压和下腔静脉高压,术后降压效果明显,并发症少,5年生存率和人工血管通畅率高,是一种可供选择的手术方式.
목적 탐토응용인공혈관행장-강-방전류술(MCAS)치료혼합형포가종합정적림상효과.방법 회고성분석2000년2월지2004년5월산동대학제로의원수치적17례혼합형포가종합정환자적림상자료.17례환자균위전부혹량지간정맥주간조새차간후하강정맥장단혈전형성혹장단폐새(혹)협착,응용인공혈관행MACS.관찰병비교환자수술전후적림상증상、문정맥급하강정맥압력;환자술후병발증발생솔;인공혈관통창솔.채용Kaplan-Meier법분석환자생존솔,χ2검험화t검험분석상관수거.결과 전조환자무위수술기사망.17례환자중15례림상증상소실혹완해,여술전비교,차이유통계학의의(χ2=9.78,P<0.05);3례출현병발증;문정맥급하강정맥압력술후교술전평균하강1.2 cm H2O(1 cm H2O=0.098 kPa)화18.5 cm H2O,기차이유통계학의의(t=2.38,3.06,P<0.05);1、3、5년생존솔분별위16/17、15/17、14/17;5년인공혈관통창솔위14/17.결론 MCAS가동시완해혼합형포가종합정적문정맥고압화하강정맥고압,술후강압효과명현,병발증소,5년생존솔화인공혈관통창솔고,시일충가공선택적수술방식.
Objective To investigate the therapeutic effect of the meso-cavo-atrial shunt (MCAS) in the treatment of combined Budd-Chiari syndrome (BCS). Methods The clinical data of 17 cases of combined BCS with all or bilateral hepatic vein occlusion and long range occlusion or obstruction of inferior vena cava (IVC) were admitted to the Qilu Hospital from February 2000 to May 2004. All patients were treated by MCAS with artificial blood vessels. The pre- and postoperative clinical symptoms, the IVC and portal venous (PV) pressures, the incidence of postoperative complications and the patency rate of the artificial vessels were analyzed. The survival of patients was analyzed using the Kaplan-Meier analysis, and the data were analyzed using the chi-square test and t test. Results No patient died during the perioperative period, and the symptoms of 15 patients disappeared or were relieved after operation, with a significant difference compared with those before operation (χ2 =9.78, P <0. 05 ). Three patients had complications after the operation. The postoperative PV and IVC pressures were decreased by 1.2 cm H2O (1 cm H2O =0.098 kPa) and 18.5 cm H2O, respectively. There were significant differences in the decrease of IVC and PV pressures ( t = 2.38, 3.06, P < 0.05 ). The 1-, 3-, 5-year survival rates were 16/17, 15/17 and 14/17, respectively, and the 5-year patency rate of the artificial vessels was 14/17.Conclusions MCAS can simultaneously relieve IVC and PV hypertension for patients with combined BCS. The postoperative complication rate was decreased, the 5-year survival rate and the patency rate of the artificial vessels were improved after the treatment, so MCAS is an optional surgical method for treating combined BCS.