CAJ | 학술논문

目的：探讨Ⅱ型布加综合征（BCS）患者肝流出静脉通畅度与腔房转流术（ACS）疗效的关系。方法回顾性分析209例应用 ACS 治疗的Ⅱ型 BCS 患者的临床资料，患者分为肝流出静脉通畅组（A 组）及肝流出静脉狭窄组（B 组）。观察并比较患者手术前后的临床症状、门静脉压力（PFP）及下腔静脉压力（IVCP），患者术后并发症发生率、人工血管通畅率。两组患者手术前后 IVCP、PFP的比较采用 t 检验，人工血管累计通畅率采用χ2检验及 Kaplan-Meier 进行分析。结果209例患者中183例临床症状消失或缓解；6例出现严重并发症，其中1例患者围手术期死于肺栓塞。A 组患者术后2周 PFP 下降较 B 组明显[A 组（2．09±0．33）kPa，B 组（2．97±0．41）kPa；（t ＝15．48，P＜0．05）]，门脉高压症状显著缓解；术后5年人工血管通畅率为80．0％，且 A 组高于 B 组（χ2＝9．32，P＜0．05）。结论肝流出静脉通畅的Ⅱ型 BCS 患者行 ACS，可同时缓解Ⅱ型 BCS 的门静脉高压症和下腔静脉高压症，且术后并发症少，人工血管通畅率高。
목적：탐토Ⅱ형포가종합정（BCS）환자간류출정맥통창도여강방전류술（ACS）료효적관계。방법회고성분석209례응용 ACS 치료적Ⅱ형 BCS 환자적림상자료，환자분위간류출정맥통창조（A 조）급간류출정맥협착조（B 조）。관찰병비교환자수술전후적림상증상、문정맥압력（PFP）급하강정맥압력（IVCP），환자술후병발증발생솔、인공혈관통창솔。량조환자수술전후 IVCP、PFP적비교채용 t 검험，인공혈관루계통창솔채용χ2검험급 Kaplan-Meier 진행분석。결과209례환자중183례림상증상소실혹완해；6례출현엄중병발증，기중1례환자위수술기사우폐전새。A 조환자술후2주 PFP 하강교 B 조명현[A 조（2．09±0．33）kPa，B 조（2．97±0．41）kPa；（t ＝15．48，P＜0．05）]，문맥고압증상현저완해；술후5년인공혈관통창솔위80．0％，차 A 조고우 B 조（χ2＝9．32，P＜0．05）。결론간류출정맥통창적Ⅱ형 BCS 환자행 ACS，가동시완해Ⅱ형 BCS 적문정맥고압증화하강정맥고압증，차술후병발증소，인공혈관통창솔고。
Objective To investigate the relationship between atrial caval shunting (ACS)curative effects for type Ⅱ Budd-Chiari syndrome (BCS)and hepatic venous outflow patency.Methods Two hundred and nine patients undergoing atrial caval shunting for type Ⅱ Budd-Chiari syndrome were retrospectively analyzed and divided into hepatic venous outflow patent group (group A)and stenotic group (group B).The preoperative and postoperative clinical symptoms were observed respectively.χ2 -test,t-test and Kaplan-Meier test were used to analyze the changes of portal free pressure (PFP)and inferior vena cava pressure (IVCP)before and after artificial blood vessels (ABV)opening,incidence of significant postoperative complications and ABV patency rates.Results The clinical symptoms of one hundred and eighty-three BCS patients were disappeared or alleviated.Severe complications occurred in six cases,with one case died from pulmonary embolism.The PFP reduction of group A was significantly lower than that of group B[(2.09 ± 0.33)kPa,(2.97 ±0.41 )kPa;(t =1 5.48,P <0.05 )],and portal hypertension syndromes in group A alleviated more greatly than that of group B.ABV patency was 80.0% for five years after surgery and group A was superior to group B (χ2 =9.32,P<0.05).Conclusions ACS treatment for hepatic venous outflow in patent with type Ⅱ BCS patients could decrease PFP and IVCP simultaneously,with lower postoperative complications and higher ABV patency rates.