Inafuku Hitoshi, Morishima Yuji, Nagano Takaaki, Arakaki Katsuya, Yamashiro Satoshi, Kuniyoshi Yukio
Department of Cardiovascular Surgery, Thoracic and Cardiovascular Surgery Division, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.
J Vasc Surg. 2009 Sep;50(3):590-3. doi: 10.1016/j.jvs.2009.03.040.
We previously reported the value of our operative procedure for Budd-Chiari syndrome (BCS) that comprised reconstruction of the occluded or severely stenosed inferior vena cava (IVC) using an autologous pericardium patch and reopening as many occluded hepatic veins as possible. Here, we present the long-term durability and efficacy of the autologous pericardium patch for reconstruction of the IVC in BCS.
We retrospectively analyzed a series of 53 consecutive patients (mean age, 48.4 +/- 12.8 years; range, 24-76 years; 34 men) who underwent surgical treatment for BCS at our institution from 1979 to 2008. Patency of the IVC and hepatic veins was examined by venography at discharge. Patients attended an outpatient clinic every 1 or 2 months for follow-up. The reconstructed IVC was evaluated by enhanced computed tomography every 1 or 2 years.
Two in-hospital (operative mortality, 3.7%) and 15 late deaths occurred. During a mean follow-up of 7.6 +/- 6.5 years (range, 0.08-24.1 years), the reconstructed IVC became totally obstructed in three patients, of whom two underwent reoperation, and severely stenosed in two patients, who required percutaneous transvenous balloon venoplasty (PTV). The 5- and 10-year patency rates without reoperation or PTV for the reconstructed IVC were 90.5% and 84.3%, respectively. The cumulative 5- and 10-year survival rates were 89.8% and 70.7%, respectively.
The autologous pericardium patch is effective and durable for reconstructing a diseased IVC in BCS.
我们之前报道了我们针对布加综合征（BCS）的手术方法的价值，该方法包括使用自体心包补片重建闭塞或严重狭窄的下腔静脉（IVC），并尽可能多地重新开通闭塞的肝静脉。在此，我们展示了自体心包补片在BCS中重建IVC的长期耐用性和疗效。
我们回顾性分析了1979年至2008年在我们机构接受BCS手术治疗的一系列53例连续患者（平均年龄48.4±12.8岁；范围24 - 76岁；34例男性）。出院时通过静脉造影检查IVC和肝静脉的通畅情况。患者每1或2个月到门诊进行随访。每1或2年通过增强计算机断层扫描评估重建的IVC。
发生了2例院内死亡（手术死亡率3.7%）和15例晚期死亡。在平均7.6±6.5年（范围0.08 - 24.1年）的随访期间，3例患者重建的IVC完全阻塞，其中2例接受了再次手术，2例患者重建的IVC严重狭窄，需要经皮经静脉球囊血管成形术（PTV）。重建的IVC未经再次手术或PTV的5年和10年通畅率分别为90.5%和84.3%。累积5年和10年生存率分别为89.8%和70.7%。
自体心包补片在重建BCS中病变的IVC方面有效且耐用。
