Zhonghua yi xue za zhi · 2008
[Treatment of Budd-Chiari syndrome with occlusion of both inferior vena cava and hepatic veins lesions by interposition of graft meso-caval-atrial shunt].
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Xue Huan-zhou, Wang Ya-dong, Jiang Qing-feng, Zhang Hong-wei, Shen Quan
Аннотация
OBJECTIVE: To evaluate the therapeutic efficacy of interposition of graft meso-cavo-atri shunt (MCAS) for the treatment of Budd-Chiari syndrome (BCS) with occlusion of both inferior cava vena (ICV) and hepatic veins (HVs).
METHODS: 51 BCS patients with combined occlusion of ICV and HVs, 30 males and 20 females, aged 18-45, underwent MCAS. A 16-18 mm ring-reinforced graft (main graft) was anastomosed firstly to the side of ICV with continuous 5/0 vascular suture, then to the side of the right atrium with continuous 5/0 vascular suture. A 10-12 mm graft (secondary graft) was anastomosed to the side of the superior mesenteric vein (SMV) with continuous 5/0 vascular suture, then to the side of the main graft with continuous 5/0 vascular suture. The pressure and blood flow of ICV and portal vein (PV) were examined before and after operation. The patients were followed up for 6 months to 16 years.
RESULTS: There was no perioperative death. During the follow-up no thrombosis of the main graft was found but thrombosis of the secondary graft occurred in two cases. The patency rates of the main and secondary grafts were 100% and 96.1% respectively. The total patency rate of graft was 96.1%. After operation the pressure of IVC and PV decreased by 17.4 +/- 5.7 cm HO2O and 17.0 +/- 7.0 cm H2O respectively compared with those before operation.
CONCLUSION: MCAS is very effective in decompression of PC and IVC. MCAS may be a valuable surgical procedure for treatment of BCS with occlusion of both ICV and HVs.
METHODS: 51 BCS patients with combined occlusion of ICV and HVs, 30 males and 20 females, aged 18-45, underwent MCAS. A 16-18 mm ring-reinforced graft (main graft) was anastomosed firstly to the side of ICV with continuous 5/0 vascular suture, then to the side of the right atrium with continuous 5/0 vascular suture. A 10-12 mm graft (secondary graft) was anastomosed to the side of the superior mesenteric vein (SMV) with continuous 5/0 vascular suture, then to the side of the main graft with continuous 5/0 vascular suture. The pressure and blood flow of ICV and portal vein (PV) were examined before and after operation. The patients were followed up for 6 months to 16 years.
RESULTS: There was no perioperative death. During the follow-up no thrombosis of the main graft was found but thrombosis of the secondary graft occurred in two cases. The patency rates of the main and secondary grafts were 100% and 96.1% respectively. The total patency rate of graft was 96.1%. After operation the pressure of IVC and PV decreased by 17.4 +/- 5.7 cm HO2O and 17.0 +/- 7.0 cm H2O respectively compared with those before operation.
CONCLUSION: MCAS is very effective in decompression of PC and IVC. MCAS may be a valuable surgical procedure for treatment of BCS with occlusion of both ICV and HVs.