目的 探討布-加綜合征的個體化治療。 方法 我們對首都醫科大學附屬復興醫院及宣武醫院、二炮總醫院及其他醫院2004年2月至2009年5月期間會診收治的20例布-加綜合征患者的臨床資料進行回顧性分析。結果 20例患者中術后24 h死亡1例（5.0%），死于DIC； 19例順利出院。19例患者術后均獲隨訪，隨訪時間（34.7±3.3）個月，其中恢復良好者占73.7%（14/19）； 1例（5.3%）行腸-腔-頸轉流術者，術后間斷出現肝性腦病，短期住院治療后可以改善； 術后18個月1例（5.3%）行腸-腔轉流術者因全身臟器衰竭死亡。結論 個體化手術治療方案可明顯提高布-加綜合征患者的生存率。
目的 探討大動脈炎所致腎動脈上腹主動脈閉塞的手術治療方法。方法 回顧性分析1例腎動脈上腹主動脈閉塞行腹主動脈-雙股動脈人工血管搭橋手術治療的患者的臨床資料,并進行文獻復習。結果 術后患者頭痛明顯好轉，血壓由術前的220/110 mm Hg(1 mm Hg=0.133 kPa)降至160/100 mm Hg,雙下肢踝肱指數由0.50升至1.19。術后2周復查CTA示人工血管通暢，術后3個月復查彩超示人工血管通暢，血壓在(140～150)/(80～95) mm Hg間波動，雙眼視力1.0左右，已恢復正常生活。結論 大動脈炎所致腎動脈上腹主動脈閉塞常會影響多個重要臟器的供血，病變復雜，手術時機及方法的正確選擇及長期抗炎治療可以提高患者的治療效果。
目的 探討布加綜合征腸房轉流術后頑固性腹水的治療。方法 對2008年收治的1例經多次治療(包括腸房轉流術)后均于短期內復發的布加綜合征患者進行回顧性分析。結果 臨床表現為重度腹水致呼吸困難，CT靜脈造影檢查示腸房人工血管通暢但血流量低，考慮吻合口狹窄所致。術中探查發現吻合口極度狹窄，用帶外支撐環的補片重建吻合口，療效滿意。結論 復雜或經多次手術或介入治療的布加綜合征患者，要遵循個體化治療原則，強調術前明確診斷及選擇正確治療方案和手術方式。
Objective To explore the clinical presentation and diagnosis and treatment of prehepatic portal hypertension （PPH） and discuss its surgical strategies. Methods Forty-six cases of PPH treated in the 2nd Artillery General Hospital and Peking Union Medical College Hospital from January 2000 to May 2009 were analyzed retrospectively, including 2 cases of Abernethy abnormality. All patients were evaluated by indirect portal vein angiography, CT angiography and (or) portal duplex system Doppler ultrasonography before treament. Surgical strategies included: 23 cases with meso-caval shunt, 8 cases with splenectomy and spleno-renal vein shunt, 1 case with porta-caval shunt, 2 cases with paraumbilical vein-jugular vein shunt, 3 cases with portal azygous disconnection, 1 cases with splenectomy and portal azygous disconnection, 1 case with sigmoidostomy and closed the fistula of sigmoid six months later, 1 case with resection of part of small intestine due to acute extensive thrombosis of portal vein system, 4 cases with selective superior mesenteric artery and (or) splenic artery thrombolytic infusion therapy, 2 cases remained no-surgical option and underwent conservative treatment. Results Forty-four patients were followed-up from 2 months to 5 years， average of 23.4 months, one patient without surgical treatment was lost. Satisfactory outcomes were obtained in 34 patients with various shunts, which expressed as a release of hypersplenism and gastrointestinal hemorrhage. Two cases were treated with meso-caval shunt because of rehemorrhage in month 13 and 24 and one died in month 8 after disconnection, one died on day 40 after thrombolytic therapy due to putrescence of intestines, one who remained no-surgical option underwent hemorrhage 4 months later, and then went well by conservative treatment. Conclusion The key of treatment of PPH is to reduce the pressure of hepatic portal vein. Surgical managements of shunt and selective superior mesenteric artery and (or) splenic artery thrombolytic infusion therapy are safe and effective, but individual treatment strategy should be performed.
Objective To explore the methods and effect of venous retransfusion of ascites on the treatment of the complicated patients with Budd-Chiari syndrome.Methods Eighteen complicated and (or) recrudescent patients with Budd-Chiari syndrome were treated by venous retransfusion of ascites between March 2006 and July 2009. The changes in abdominal girth, body weight, the urine volume of 24 h, liver function, renal function, and serum electrolyte measurements before and after treatment were compared. Results After retransfusion of 5 000 ml to 7 800 ml (mean 6 940 ml) ascites, the abdominal girth of patients decreased (Plt;0.05), the urine volume of 24 h tended to normal and during which no serious side-effect happened. The levels of serum BUN, CREA, prothrombin time (PT), and activated partial thromboplastin time (APTT) decreased significantly (Plt;0.05), furthermore the levels of total albumen and albumin increased significantly (Plt;0.05). The changes of serum electrolyte measurements were not significant (Pgt;0.05). The follow-up period for all the patients was in the range of 4 to 37 months (mean 19 months). Then 12 patients were treated by the second operation at 3-6 months after discharge. Conclusions The ascites retransfusion provides a safe and effective treatment option for patients with refractory ascites, and yields a higher likelihood of discharge compared with conventional paracentesis. It is useful in improving quality of life and winning the operational chance for such as patients with complicated Budd-Chiari syndrome.
目的 探討對側頸動脈已被切除的頸動脈體瘤的手術方法。方法 左頸動脈體瘤患者1例，女，54歲。右側頸動脈31年前因右頸動脈體瘤手術已經切除，本次手術以成對的蚊式鉗逐步直接分離至瘤體與頸內動脈的Gordon-Tayler白線，在保證頸內動脈完整的情況下，完整切除瘤體及包裹其內的頸外動脈。結果 患者術后無聲音嘶啞、嗆咳、頭暈等并發癥，順利出院。結論 充分的術前準備及正確的分離平面是保證手術順利的關鍵。