ObjectiveTo analyze the effect of modified B-T shunt for the treatment of complex congenital heart disease. MethodsWe retrospectively analyzed the clinical data of 150 B-T case times performed in 143 patients with complex congenital heart disease in Shanghai Xinhua Hospital between July 2006 and January 2013.There were 100 case times for male patients and 50 case times for female patients with age of 2-756 (20.17 ±80.37) months and weight of 4-63 (8.86 ±9.69) kg. ResultsThere were 5 in-hospital deaths (mortality at 3.50%). Three patients occurred abnormal bleeding (2.10%). Five patients (3.50%) performed the second B-T because of shunt occlusion. And the other patients recovered uneventfully. A total of 129 case times were followed up for 6-48 (14.38±10.05) months. Seven B-T case times (5.43%) were performed in 6 patients again because of shunt occlusion during the follow-up. Three patients died during the follow-up (mortality at 2.33%). A total of 88 patients of survival underwent corrective surgery or stage Ⅱ palliative surgery (68.22%). Main pulmonary artery have a significant increase in diameter during the follow-up(t=-15.18, P=0.00). Postoperative diameters of left pulmonary artery (t=-13.27, P=0.00), right pulmonary artery (t=-15.94, P=0.00), and right pulmonary artery (t=2.44, P=0.02) increased with statistical differences compared with preoperative values. Growth in ipsilateral pulmonary of B-T is better than that of the contralateral pulmonary (t=2.44, P=0.02). McGoon ratio increased significantly after B-T (t=10.10, P=0.00). Ejection fraction value was slightly lower than the preoperative value (t=2.77, P=0.00). Left ventricular mass index increased significantly compared with the preoperative value(t=-9.26, P=0.00). ConclusionsThe modified B-T shunt has been proved to be safe and effective in treating for complex congenital heart disease. It can significantly promote the development of pulmonary artery, especially the ipsilateral pulmonary of B-T. Small McGoon ratio and pulmonary atresia are the risk factors for limiting the further development of pulmonary. Appropriate diameter of B-T shunt choice according to preoperative pulmonary diameter and the weight of the patients is the basis to ensure successful operation and a good prognosis.
ObjectiveTo evaluate the CT findings and causes of thrombosis formation after transjugular intrahepatic portosystemic shunt (TIPS). MethodsOne hundred forty-two patients with cirrhosis after TIPS were included. The imaging features of thrombus in the stent after TIPS were recorded and causes of thrombosis formation were analyzed. The presence, location and amount of thrombus, the location of ends of TIPS stent were analyzed. ResultsThe incidence of thrombosis formation after TIPS was 19.0% (27/142). The thrombus could locate around the upper end (7.4%), lower end (18.6%) of the stent and inside the stent (74.0%), there was significant differences in the incidence of stent thrombosis in different locations (P < 0.05). The thrombus might presented as little mural thrombus (12/27, 44.4%), marked thrombus (3/27, 11.1%) and thrombotic occlusion (12/27, 44.4%), there was a significant difference in the incidence of stent thrombosis with different thrombus volume (P < 0.05). There were stent outlet vascular stenosis in most patients with stent thrombosis (88.9%). ConclusionsStent thrombosis after TIPS is common. Dual source computed tomography angiography could evaluate the thrombotic features. Stent outlet vascular stenosis might be associated with thrombosis formation after TIPS.
目的 探讨肠腔分流术或联合下腔静脉内支架置入术治疗布-加氏综合征（BCS）的效果。方法 回顾性分析15例肠腔分流术或联合下腔静脉内支架置入术治疗BCS的临床资料。结果4例行肠腔侧侧直接吻合，11例应用PTFE人造血管行肠腔分流； 12例联合下腔静脉内支架置入术。门静脉压降低10～27cmH2O（0.98～2.65kPa)。1例术后因肝昏迷肝功能衰竭死亡。14例存活患者肝脾肿大缩小，腹水消失，无并发症，随访5～26个月，均恢复正常生活。结论 肠腔分流或联合下腔静脉内支架置入术成功率高，创伤小，疗效满意，是治疗BCS的有效实用术式。
Objective To explore the causes and treatment of rebleeding after operation on portal hypertension patients. Methods The clinical data of 41 rebleeding cases underwent the operational between January 2000 and December 2009 in Peking Union Medical College Hospital were retrospectively analyzed. Results All 13 cases who got rebleeding after shunt operation received lienectomy, but for those who got rebleeding after lienectomy, 23 patients received Phemister or modified Phemister or expanded lienectomy and 5 patients received shunt operation. Surgical related complications occurred in 7 cases (17.1%) at 2 weeks after operation, including abdominal bleeding (3 cases), gastrointestinal bleeding (2 cases), and intractable ascites (2 cases). After the follow-up of 3-60 months (mean 39 months), all patients were still alive. During the follow-up, 3 cases of recurrent esophageal varices were observed and one of them got rebleeding.Conclusion The majority of rebleeding after lienectomy tend to be ascribed to the wrong operations chose, while bad operation skill often contribute to the rebleeding after shunt operation, suggesting ideal therapeutic effect for rebleeding can benefit from appropriate operation choose.
目的探讨防止限制性门腔静脉侧侧分流术后吻合口扩大的方法。方法对32例肝硬变门脉高压症患者行限制性门腔静脉分流术，术中采用不吸收缝线连续缝合门腔静脉吻合口前后壁形成自然的限制环，以防止术后吻合口的扩大。结果32例患者于术后3～36个月行彩超或螺旋CT检查，显示门腔静脉吻合口均无扩大； 术后再出血率为3.1%（1/32），肝性脑病发生率为6.3%（2/32）； 术后≤6个月时肝功能均有不同程度改善，与术前比较其差异有显著性（P＜0.001）； 全部病例随访6~49个月，随访率为100%。结论改良的限制性门腔静脉侧侧分流术是治疗肝硬变门脉高压症的有效方法。
Objective To explore the treatment of a case of clonorchiasis with Budd-Chiari syndrome through multidisciplinary team (MDT) discussion. Methods A case of clonorchiasis with Budd-Chiari syndrome was treated in the Second Affiliated Hospital of Chongqing Medical University in August 2021. We summarized the discussion of MDT and the process of diagnosis and treatment. Results The patient was admitted because of “more than 8 years after partial hepatectomy and more than 1 year of abdominal distension”. Eight years before admission, the patient underwent right hepatic trisegmentectomy and left hepaticojejunostomy due to a huge space occupying right liver. Postoperative pathological examination revealed multifocal necrosis with granulomatous reaction, and parasitic infection was considered. One year before admission, the patient began to have ascites, and the medical treatment was ineffective. The CT examination of the upper abdomen after admission showed hepatic segmental stenosis of the inferior vena cava, unclear display of the hepatic veins and a large amount of ascites. After MDT discussion, this patient underwent direct intrahepatic portosystemic shunt (DIPS) and percutaneous transluminal angioplasty (PTA) , and the stent was unobstructed in the 9-month follow-up after discharge, and no recurrence of ascites was found. Conclusions DIPS combined with PTA can significantly improve the clinical symptoms of clonorchiasis with Budd-Chiari syndrome. Discussion through MDT mode can improve the effectiveness of treatment and obtain better prognosis.