Stringer M D, Howard E R, Green D W, Karani J, Gimson A S, Williams R
Department of Surgery, King's College Hospital, Denmark Hill, London, UK.
Br J Surg. 1989 May;76(5):474-8. doi: 10.1002/bjs.1800760516.
The Budd-Chiari syndrome, arising from hepatic venous outflow obstruction, is frequently complicated by inferior vena caval occlusion or obstruction. Satisfactory decompression of the liver by either portacaval or mesocaval shunts may therefore prove impossible or be prone to failure from shunt thrombosis. The mesoatrial shunt which allows the portal vein to drain directly into the right atrium has previously been advocated in this situation. Five patients with the Budd-Chiari syndrome and caval occlusion and/or obstruction have had mesoatrial shunts constructed using externally supported polytetrafluoroethylene grafts. A single thoracoabdominal incision, incorporating a median sternotomy, was found to provide a satisfactory approach. All patients recovered well with resolution of ascites, diminution in liver size and improvement in inferior vena caval pressure gradients. Furthermore, all shunts have remained patent, as determined by Doppler flow studies and contrast-enhanced computed tomographic scanning, during follow-up periods ranging from 9 to 16 months. If these results are supported by longer term studies, the mesoatrial shunt may become the surgical treatment of choice in patients with hepatic vein occlusion and the Budd-Chiari syndrome associated with inferior vena caval obstruction.
布-加综合征由肝静脉流出道梗阻引起，常并发下腔静脉闭塞或梗阻。因此，通过门腔分流术或肠系膜上腔静脉分流术对肝脏进行满意的减压可能无法实现，或者容易因分流血栓形成而失败。在这种情况下，以前曾提倡采用使门静脉直接引流至右心房的肠系膜心房分流术。5例布-加综合征合并下腔静脉闭塞和/或梗阻的患者接受了使用外部支撑的聚四氟乙烯移植物构建的肠系膜心房分流术。发现采用包括正中胸骨切开术的单一胸腹联合切口可提供满意的手术入路。所有患者恢复良好，腹水消退，肝脏体积缩小，下腔静脉压力梯度改善。此外，通过多普勒血流研究和对比增强计算机断层扫描确定，在9至16个月的随访期内，所有分流均保持通畅。如果这些结果得到长期研究的支持，肠系膜心房分流术可能会成为肝静脉闭塞和与下腔静脉梗阻相关的布-加综合征患者的首选手术治疗方法。
