Surgical treatment of 1360 cases of Budd-Chiari syndrome: 20-year experience.

ABSTRACT

BACKGROUND: Budd-Chiari syndrome (BCS) is a disease caused by blood flow obstruction of the main hepatic veins (MHVs) and/or the outlet of the inferior vena cava (IVC), characterized by retrohepatic portal hypertension (PHT) and/or IVC hypertension. In the past decade, over 3000 cases of BCS have been reported in China. This study was to sum up our 20-year experience in surgical treatment of BCS and to investigate its pathological classification and principles of surgery. METHODS: The data from 1360 BCS patients were analyzed retrospectively. RESULTS: Four types (6 subtypes) were classified according to IVC angiography and hepatovenography type Ia (594 patients), type Ib (123), type II (292), type IIIa (237), type IIIb (112), and type IV (2). Surgical procedures included improved splenopneumopexy (265 cases), finger or balloon membranotomy (407), radical resection of membrane and thrombus (275), IVC bypass (88 cavocaval transflow 71 cases, and cavoatrial transflow 17 cases), mesocaval C-shape shunt (192), splenocaval shunt (32), splenoatrial shunt (23), splenojugular shunt (57), mesoatrial shunt (8), and combined methods (6), including plenal-cavoatrial shunt (4), and mesocavoatrial shunt (2), splenorenal shunt (4), mesojugular shunt (2), and other methods (1). The perioperative death rate and the complication rate after operation was 3.09% (42/1360) and 14.8% (201/1360) respectively. 885 cases were followed up from 9 months to 15 years (average 6.8+/-1.2 years. The 791 (89.4%) of 885 patients were successfully treated, 61 patients (6.89%) had a recurrence, and 33 died. CONCLUSION: Surgical treatment of BCS is dependent on a correct diagnosis and classification of the disease.