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。
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。
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.
目的 探討肝外型門靜脈高壓分流術人工血管閉塞后血流重建的診治方法。方法 對2006年3月至2010年12月期間筆者收治的102例肝外型門靜脈高壓患者進行了開放手術治療，其中3例是再次手術患者并對已嚴重狹窄或閉塞的人工血管進行了血流重建。結果 3例患者人工血管均得以血流重建，分別隨訪了32、17及30個月，患者均已恢復正常生活。結論 合適的病例選擇、合理的手術方案以及術中和術后規范的抗凝治療是保證門靜脈高壓分流術后人工血管長期通暢的重要因素。