Chang C H, Lee M C, Shieh M J, Chang J P, Lin P J
Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China.
Ann Thorac Surg. 1989 Sep;48(3):409-12. doi: 10.1016/s0003-4975(10)62867-6.
In a 7-year period, transatrial membranotomy was performed in 11 patients with membranous obstruction of the inferior vena cava. There were 5 men and 6 women, ranging in age from 23 to 53 years. Clinical symptoms included jaundice in 4 patients, hepatomegaly in 4, leg edema or varicose veins in 10, and venous collaterals over the abdominal and chest wall in all 11 patients. Transatrial membranotomy was performed through a median sternotomy in all patients. When inferior vena cava venography revealed that the obstruction was accompanied by long segmental thrombosis, additional dilation was performed with a Hegar dilator. There was no surgical mortality. Early operative complications included pulmonary embolism in 2 patients and bleeding requiring reoperation in 1. In a mean follow-up period of 30.6 months (range, 2 to 88 months), 9 patients had no symptoms, transient pericardial constriction developed in 1 patient and resolved 1 month later, and restenosis of the inferior vena cava developed in another patient 1 year after the first operation. This latter patient received a second transatrial membranotomy followed by percutaneous balloon angioplasty of the inferior vena cava, with a satisfactory result at 8 months follow-up. We conclude that transatrial membranotomy is an effective and safe procedure for patients with membranous obstruction of the inferior vena cava.
在7年的时间里，对11例下腔静脉膜性梗阻患者实施了经心房膜切开术。其中男性5例，女性6例，年龄在23至53岁之间。临床症状包括4例黄疸、4例肝肿大、10例腿部水肿或静脉曲张，所有11例患者均有腹壁和胸壁静脉侧支循环。所有患者均通过正中胸骨切开术进行经心房膜切开术。当下腔静脉造影显示梗阻伴有长段血栓形成时，用黑加扩张器进行额外扩张。无手术死亡病例。早期手术并发症包括2例肺栓塞和1例因出血需要再次手术。平均随访期为30.6个月（范围为2至88个月），9例患者无症状，1例患者出现短暂性心包缩窄，1个月后缓解，另1例患者在首次手术后1年出现下腔静脉再狭窄。该患者接受了第二次经心房膜切开术，随后进行了下腔静脉经皮球囊血管成形术，随访8个月时效果满意。我们得出结论，经心房膜切开术对于下腔静脉膜性梗阻患者来说是一种有效且安全的手术方法。
