Zamboni P, Pisano L, Mari C, Galeotti R, Feo C, Liboni A
Institute of General Surgery and Vascular Laboratory, University of Ferrara, Italy.
J Cardiovasc Surg (Torino). 1996 Dec;37(6):583-7.
Membranous obstruction of the inferior vena cava (MOIVC) is a rare, congenital or acquired, cause of Budd-Chiari syndrome leading to hepatocellular carcinoma in 20 to 40% of the patients. It has a very poor prognosis when treated medically and balloon angioplasty (PTA) represents, nowadays, the treatment of choice, having no mortality or significant morbidity with follow-up as long as 5 years; transatrial membranotomy, direct reconstruction of IVC and bypass surgery are alternative techniques when PTA is not feasible. One case of Budd-Chiari syndrome due to an incomplete membranous obstruction of the suprahepatic portion of the inferior vena cava is reported. A PTA was not feasible as it was not possible to pierce the membranous obstruction. A successful inferior vena cava-right atrium PTFE bypass, with a 3.5-year follow-up, was performed. This surgical approach is a valuable alternative to transatrial membranotomy and direct reconstruction of the IVC.
下腔静脉膜性梗阻（MOIVC）是布加综合征一种罕见的病因，可为先天性或后天性，在20%至40%的患者中会导致肝细胞癌。药物治疗预后很差，而球囊血管成形术（PTA）目前是首选治疗方法，随访长达5年无死亡率或显著发病率；当PTA不可行时，经心房膜切开术、下腔静脉直接重建术和搭桥手术是替代技术。本文报告1例因下腔静脉肝上段不完全膜性梗阻导致的布加综合征。由于无法穿透膜性梗阻，PTA不可行。成功实施了下腔静脉-右心房聚四氟乙烯搭桥术，并进行了3.5年的随访。这种手术方法是经心房膜切开术和下腔静脉直接重建术的一种有价值的替代方法。
