Kuniyoshi Y, Koja K, Akasaki M, Miyagi K, Shimoji M, Kudaka M, Uezu T
Second Department of Surgery, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.
Ann Thorac Surg. 1998 Jun;65(6):1711-4. doi: 10.1016/s0003-4975(98)00293-8.
In the past 17 years, 32 patients with Budd-Chiari syndrome were treated by reconstruction of the occluded inferior vena cava and reopening of the hepatic veins under femoro-femoral normothermic extracorporeal partial bypass. The mean follow-up was 8 years (range, 1.5 to 17 years).
To evaluate the benefits of our operative procedure, we compared the preoperative, early postoperative, and late postoperative endoscopic appearance of the esophageal varices and the histologic findings of the liver tissue obtained intraoperatively and at a later date.
The esophageal varices found preoperatively in 29 patients (90.6%) had disappeared in 7 patients by the time of discharge, and in 2 patients they disappeared 4 to 7 years after surgery. In the remaining 20 patients, the grade of the esophageal varices was reduced markedly. Histologic examination of the liver showed cirrhosis in 22 patients, fibrosis in 9 patients, and severe congestion in 1 patient. Inspection of the liver in the late postoperative period (in 10 patients) showed improvement in centrilobular congestion and no increase in interlobular fibrosis.
Gradual and steady improvement of esophageal varices and hepatic fibrosis can be achieved after our operative procedure.
在过去17年中，32例布加综合征患者在股-股常温体外部分转流下接受了闭塞下腔静脉重建及肝静脉再通治疗。平均随访时间为8年（范围1.5至17年）。
为评估我们手术方法的益处，我们比较了术前、术后早期及晚期食管静脉曲张的内镜表现以及术中及后期获取的肝组织的组织学结果。
术前29例患者（90.6%）存在食管静脉曲张，其中7例在出院时消失，2例在术后4至7年消失。其余20例患者食管静脉曲张程度明显减轻。肝脏组织学检查显示22例患者有肝硬化，9例有纤维化，1例有严重淤血。术后晚期（10例患者）肝脏检查显示小叶中心淤血改善，小叶间纤维化未增加。
我们的手术方法可使食管静脉曲张和肝纤维化逐渐稳步改善。
