Management of severe Budd-Chiari syndrome: report of 147 cases.

BACKGROUND: Budd-Chiari syndrome (BCS) is an uncommon disorder caused by the obstruction of hepatic venous outflow and/or the inferior vena cava. Major therapeutic approaches include operation and radiological intervention. This study was conducted to investigate the treatment of severe BCS. METHODS: The clinical data of 147 patients with severe BCS who had been treated at our hospital from November 1994 to December 2003 were retrospectively analyzed. RESULTS: One hundred twenty-one patients with BCS underwent surgery, including mesocaval C type shunt with artificial graft (82 patients), splenojugular shunt (37), mesojugular shunt (2), percutaneous transhepatic recanalization and dilatation and/or stent placement of the main hepatic vein (MHV) (12), and combined percutaneous transhepatic angioplasty (PTA) and stent placement of the inferior vena cava and mesocaval shunt (14). Follow-up for 6-108 months showed excellent results in 102 patients (69.4%), good results in 40 (27.2%), and 5 deaths. CONCLUSION: Good results could be obtained in most of patients with BCS after different surgical treatments according to the pathological changes of the IVC and MHV.

Diagnosis and treatment of insulinoma: report of 105 cases.

OBJECTIVE: To study the methods for diagnosis and treatment of insulinoma. METHODS: Clinical data from 105 patients with insulinoma who had been admitted to our hospital from July 1966 to December 1999 were retrospectively reviewed. RESULTS: Fasting blood glucose values were less than 2.75 mmol/L in all the patients. Fasting serum insulin values in 60 patients were higher than 25 mU/L, average 65 mU/L. Before operation, carcinoma was detected in 2 of 45 patients by ultrasound scan, and in 10 of 35 by CT. Enucleation of insulinoma was performed in 60 patients. Operations included insulinoma resection (35 patients), distal resection of the pancreas (8), and biopsy (2). CONCLUSION: Whipple's triad and the index of insulin release >0.3 are the major variables for diagnosis. Intraoperative exploration and ultrasound scan are the methods for the localization of insulinoma. Enucleation of benign insulinoma is preferred, but proximal or distal resections of the pancreas are required only for large, deep or multiple tumors.

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

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.