中国实用外科杂志

中国实用外科杂志

• 论著 • 上一篇    下一篇

肝素化后自体血回收回输施行布加综合征根治术57例分析

刘    健，黄击修，林小彬，付    建，刘    勇   

  1. 简阳市人民医院心血管外科，四川简阳641400
  • 发布日期:2012-05-28

  • Published:2012-05-28

摘要：

目的    总结肝素化后自体血回收、回输施行布加综合征（BCS）根治术的临床治疗经验。 方法    回顾分析1997年11月至2011年5月简阳市人民医院心血管外科在非体外循环下实施57例BCS根治术病人的临床资料。手术要点是在全身肝素化前提下，实现下腔静脉远端球囊阻断、控制性放血、负压吸引血液回收、经右心插管血液回输等关键技术环节，同时在直视下完成对下腔静脉、肝静脉阻塞性病变的处理。 结果    术前下肢深静脉压力（17.5~30.3）mmHg（1 mmHg=0.133 kPa） ，平均（25.3±3.6）mmHg，术后下降为（9~13）mmHg，两者差异有统计学意义。术中回收回输自体血量600~40 000 mL，其中超过10 000 mL者8例；除1例术中发生下腔静脉破裂、大量失血而于术中、术后输异体血外，其余病人术中均未输异体血。无上消化道大出血、肝昏迷、急性肾功能衰竭、肺动脉栓塞等手术并发症。围手术期死亡1例（1.82%），死于不能有效控制的下腔静脉破裂出血。 结论    肝素化后自体血回收、回输技术简化了体外循环和深低温停循环下BCS根治术的手术程序，保证了手术效果。

关键词: 布加综合征, 失血, 肝素

Abstract:

Open angioplasty of Budd-Chiari syndrome with self-blood recovery and transfusion after heparinization: an analysis of 57 cases     LIU Jian,HUANG Ji-xiu,LIN Xiao-bin,et al. Department of Cardiovascular Surgery, the People’s Hospital of Jianyang, Jianyang  641400, China
Corresponding author：LIU Jian, E-mail:liujiun688@sina.com
Abstract    Objective    To summarize the experience of treatment on open angioplasty of Budd-Chiari syndrome (BCS) in heparinization and no cardiopulmonary bypass (N-CPB). Methods    The clinical data of 57 cases of  BCS performed open angioplasty in heparinization and N-CPB from November 1997 to May 2011 at the People’s Hospital of Jianyang were analyzed retrospectively. The operation includes following key points: heparinization of blood but N-CPB, blocking the distal side of the obstruction in inferior vena cava by a Foley’s catheter, blooding controlled, blood retrieved by negative pressure and the blood transfused through the cannulas in right atrium. Results    The inferior vena cava pressure dropped obviously (from 17.5-30.3 mmHg to 9-13 mmHg) with significant difference. Self-blood volume transfused 600-40 000 mL in per case. The self-blood volume transfused was over 10 000 mL in 8 cases. All cases didn’t transfuse stocking blood in operating period except for 1 case. There were not serious complications occurred including upper gastrointestinal haemorrhage, hepatic coma, acute renal failure and pulmonary artery embolism, ect. One case(1.82％) died in 24 hours after operation due to bleeding of inferior vena cava．Conclusion    Compared with the way in CPB and deep hypothermic circulatory arrest, open angioplasty with self-blood recovery and transfusion after heparinization may simplify processes on open angioplasty of BCS, reduce operating injury and ensure the effect of operation.

Key words: Budd-Chiari syndrome, blood loss, heparin