中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2013年
2期
131-134
,共4页
吴性江%曹建民%韩建明%黎介寿
吳性江%曹建民%韓建明%黎介壽
오성강%조건민%한건명%려개수
肝静脉血栓形成%门体分流术,经颈静脉肝内
肝靜脈血栓形成%門體分流術,經頸靜脈肝內
간정맥혈전형성%문체분류술,경경정맥간내
Hepatic vein thrombosis%Protasystemic shunt,transjugular intrahepatic
目的 分析肝静脉闭塞型巴德-吉亚利综合征(BCS)的治疗方法.方法 回顾性分析1995年5月至2012年2月收治的50例肝静脉型BCS患者的临床资料.男性23例,女性27例；平均年龄(39±11)岁,肝功能Child-Pugh评分(9.6±2.6)分.肝静脉近段闭塞12例,肝静脉闭塞合并下腔静脉狭窄6例,全肝静脉闭塞19例,肝小静脉闭塞13例.急性3例,亚急性或慢性47例.患者主要表现为食管静脉曲张破裂出血和顽固性腹水,采用多普勒超声、CT血管造影或磁共振血管造影、上消化道钡餐、血管造影明确诊断.治疗方法包括:肝静脉成形术12例,肝静脉成形加下腔静脉成形术6例,经颈静脉肝内门体静脉分流术(TIPS)13例,改良TIPS 19例.结果 所有患者均成功完成手术.TIPS或改良TIPS术后,门静脉压力由(41±10)cmH2O(1 cmH2O=0.098 kPa)下降至(27±6)cmH2O(t =20.20,P=0.001),门静脉血流速度由(14±10)cm/s增至(52±14)cm/s(t=15.02,P=0.001).患者出血控制,腹水渐消退,肝功能明显好转.住院期间因肝功能不全死亡1例,肝门分流道急性阻塞1例.术后随访12 ～ 204个月,平均随访时间(82±46)个月,分流道狭窄行扩张内支撑2例,肝静脉狭窄再扩张2例.结论 肝静脉成形术和TIPS是治疗肝静脉型BGS的有效方法.
目的 分析肝靜脈閉塞型巴德-吉亞利綜閤徵(BCS)的治療方法.方法 迴顧性分析1995年5月至2012年2月收治的50例肝靜脈型BCS患者的臨床資料.男性23例,女性27例；平均年齡(39±11)歲,肝功能Child-Pugh評分(9.6±2.6)分.肝靜脈近段閉塞12例,肝靜脈閉塞閤併下腔靜脈狹窄6例,全肝靜脈閉塞19例,肝小靜脈閉塞13例.急性3例,亞急性或慢性47例.患者主要錶現為食管靜脈麯張破裂齣血和頑固性腹水,採用多普勒超聲、CT血管造影或磁共振血管造影、上消化道鋇餐、血管造影明確診斷.治療方法包括:肝靜脈成形術12例,肝靜脈成形加下腔靜脈成形術6例,經頸靜脈肝內門體靜脈分流術(TIPS)13例,改良TIPS 19例.結果 所有患者均成功完成手術.TIPS或改良TIPS術後,門靜脈壓力由(41±10)cmH2O(1 cmH2O=0.098 kPa)下降至(27±6)cmH2O(t =20.20,P=0.001),門靜脈血流速度由(14±10)cm/s增至(52±14)cm/s(t=15.02,P=0.001).患者齣血控製,腹水漸消退,肝功能明顯好轉.住院期間因肝功能不全死亡1例,肝門分流道急性阻塞1例.術後隨訪12 ～ 204箇月,平均隨訪時間(82±46)箇月,分流道狹窄行擴張內支撐2例,肝靜脈狹窄再擴張2例.結論 肝靜脈成形術和TIPS是治療肝靜脈型BGS的有效方法.
목적 분석간정맥폐새형파덕-길아리종합정(BCS)적치료방법.방법 회고성분석1995년5월지2012년2월수치적50례간정맥형BCS환자적림상자료.남성23례,녀성27례；평균년령(39±11)세,간공능Child-Pugh평분(9.6±2.6)분.간정맥근단폐새12례,간정맥폐새합병하강정맥협착6례,전간정맥폐새19례,간소정맥폐새13례.급성3례,아급성혹만성47례.환자주요표현위식관정맥곡장파렬출혈화완고성복수,채용다보륵초성、CT혈관조영혹자공진혈관조영、상소화도패찬、혈관조영명학진단.치료방법포괄:간정맥성형술12례,간정맥성형가하강정맥성형술6례,경경정맥간내문체정맥분류술(TIPS)13례,개량TIPS 19례.결과 소유환자균성공완성수술.TIPS혹개량TIPS술후,문정맥압력유(41±10)cmH2O(1 cmH2O=0.098 kPa)하강지(27±6)cmH2O(t =20.20,P=0.001),문정맥혈류속도유(14±10)cm/s증지(52±14)cm/s(t=15.02,P=0.001).환자출혈공제,복수점소퇴,간공능명현호전.주원기간인간공능불전사망1례,간문분류도급성조새1례.술후수방12 ～ 204개월,평균수방시간(82±46)개월,분류도협착행확장내지탱2례,간정맥협착재확장2례.결론 간정맥성형술화TIPS시치료간정맥형BGS적유효방법.
Objective To determine the outcome of hepatic venousaplasty and transjugular intrahepatic portosystemic shunt(TIPS)in the treatment of the Budd-Chiari syndrome with occlusion of the hepatic veins.Methods Fifty patients of the Budd-Chiari syndrome with occlusion of the hepatic veins (23 males and 27 females,with a mean age of(39 ± 11)years)were elected for venousaplasty or TIPS.The average of Child-Pugh scores was 9.6 ± 2.6.Three patients had a acute coarse of the disease,while 47 patients had a subacute or a chronic course of the disease.The clinical presentation was ascites in all 50 cases,with concomitant upper gastrointestinal bleeding in 10 patients,hepatorenal syndrome in 4 patients and impaired liver function in all patients.Hepatic venousplasty was performed for 12 patients with occlusion of hepatic venous.Hepatic and inferior caval venousplasty were performed for 6 patients with occlusion of hepatic and inferior caval vein.TIPS was performed for 13 patients with occlusion of small hepatic vein.Modified TIPS was performed for 19 patients with extensive occlusion of hepatic vein.Results The procedure of treatment was successfully performed in all patients.The shunt reduced the portosystemic pressure gradient from(41 ±10)to(27±6)cmH2O(1 cmH2O =0.098 kPa,t =20.20,P=0.001)and improved the portal flow velocity from(14 ± 10)to(52 ± 14)cm/s(t =15.02,P =0.001)after TIPS or modified TIPS.Clinical symptoms and the biochemical test results improved significantly during 3 weeks after hepatic venousplasty and shunt treatment.During the hospitalization,the death occurred in 1 case due to hepatic failure and the acute occlusion of shunt was treated with secondary intervention in another case.The mean follow-up was(82 ± 46)mouths.The revisions of shunt with TIPS were needed in 2 patients and the inflation of stenosised hepatic vein in another 2 patients during the follow-up.All patients were still observed.Conclusion Hepatic venousaplasty and TIPS provide an excellent outcome in patients of Budd-Chiari syndrome with occlusion of the hepatic veins.
