摘要
目的探讨肠系膜上静脉-下腔静脉-右心房人工血管“Y”型架桥术（简称肠-腔-房人工血管“Y”型架桥术）在混合型B-CS治疗中的应用价值。方法对101例混合型B-CS病人中的临床资料进行对比研究，其中肠-腔-房人工血管“Y”型架桥术62例，脾静脉-腔静脉人工血管架桥术（简称脾-腔人工血管架桥术）26例，肠系膜上静脉-下腔静脉人工血管架桥术（简称肠-腔人工血管架桥术）13例。结果肠-腔-房人工血管“Y”型架桥术62例（简称肠-腔-房组）手术后血小板数明显升高（P〈0．05）。脾-腔人工血管架桥术26例（简称脾-腔组）和肠-腔人工血管架桥术13例（简称肠-腔组）手术后血小板数无明显升高（P〉0．05）。分流前后三组门静脉压力变化情况：肠-腔-房组均下降（P〈0．05），脾-腔组和肠-腔人工血管架桥术组（简称肠-腔组）无明显下降（P〉0．05）。术后进行1年的随访，三组肝性脑病发生率分别为3．2％（2／62）、0％（0／26）和0％（0／13），三组肝性脑病发生率之间的差异无显著性意义（P〉0．05）。三组人工血管通畅情况，有效率分别为95．2％（59／62）、69．2％（18／26）和38．4％（5／13），肠-腔-房组与脾-腔组和肠-腔组之间的人工血管均通畅率比较有显著性差异（P〈0．05）。结论肠-腔-房人工血管“Y”型架桥术在降低门静脉和下腔静脉压力及控制上消化道出血方面达到了满意的效果，且可同时消除病人脾功能亢进。脾-腔人工血管架桥术和肠-腔人工血管架桥术在治疗混合型B-CS效果非常不理想，不能达到治疗效果。
Objective To explore the application value of superior mesenteric vein-cavat-right atrium Y shape shunt （abbr. SMV-CV-RA Y shape shunt） as a new approach for treatment of mixed pattern Budd-Chiari syndrome （B-CS）. Methods The clinical data of 101 cases of mixed pattern B-CS patients were evaluated for the curative effect. Of the 101 patients, 62 were treated with superior mesenteric vein-caval-right atrium Y shape shunt, 26 with splenic vein-caval shunt and 13 with superior mesenteric vein-caval shunt using artificial vascular graft. Results Compared with the plastocyte count of patients receiving splenic vein-caval shunt and superior mesenteric vein-caval shunt, the plastocyte count of 62 cases undergoing SMV-CV-RA shunt increased obviously after operation （P〈0.05）. The portal vein pressure of patients with SMV-CV-RA shunt decreased significantly （P〈 0.05）, but the pressure of patients in splenic vein-caval shunt group and superior mesenteric vein-caval shunt group deceased slightly （P〉0. 05）. The incidence of hepatic encephalopathy in one year after operation was not significantly different among the 3 groups （P〉0.05）. The incidence was 3.2% （2/ 62）, 0% （0/26）, 0% （0/13）, respectively. The recanalization rate of artificial vascular graft was 95.2%（59/62）, 69.2%（18/26）, 38.4%（5/13）, respectively in SMV-CV-RA shunt group, splenic vein-caval shunt group and superior rnesenterie vein-caval shunt group. The recanalization rate of artificial vascular graft in SMV-CV-RA shunt group was increased significantly （P〈0. 05）. Conclusion Compared with splenic vein-caval shunt and superior mesenterie vein-caval shunt, the SMV-CV-RA Y shape shunt can get satisfactory effect in curing massive hemorrhage of gastrointestinal tract for cutting down the pressure of portal vein and inferior vena. Otherwise, the shunt could eliminate hypersplenia of patients. The splenic vein caval shunt and superior mesenteric vein-caval shunt are not effective in curing the mixed pattern B-CS.
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2009年第10期723-727,共5页
Chinese Journal of Hepatobiliary Surgery
