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.

Triplex operation for portal hypertension with esophageal variceal bleeding: report of 140 cases.

BACKGROUND: Portal hypertension is a common disease. The surgical therapy of this disease focuses on the resultant upper digestive tract bleeding, which can imperil patients' life directly. This study was to evaluate the effect of triplex operation (mesocaval C shunt with artificial graft, ligation of the coronary vein and splenic artery) on portal hypertension and its associated upper digestive tract bleeding. METHODS: A retrospective study was made on clinical data of 140 patients undergoing triplex operation, who had suffered from portal hypertension and upper digestive tract bleeding. RESULTS: Postoperative portal pressure was 25-43 cmH2O(preoperative portal pressure 27-45 cmH2O) with the average reduction of 10 cmH2O. One patient (0.7%) died of cerebrovascular disease. Five patients (3.5%) suffered from mild hepatic encephalopathy, which was ameliorated through conservative treatment. Lymphatic fistula occurred in 3 patients (2.1%) who recovered without treatment 5, 10 days and 3 months after operation respectively. One hundred patients were followed up for 1 month to 6 years without recurrent hemorrhage or hepatic encephalopathy. Hypersplenism and ascites disappeared in 70 patients (70%) and 80 patients (80%) respectively. A significant reduction of ascites was seen in 12 patients(12%). The artificial vessels remained unblocking detected by B type ultrasonography and Doppler sonography in 95 patients(95%). CONCLUSION: Triplex operation is suitable for patients with the following portal hypertensions: portal hypertension caused by simple occlusion of the hepatic vein (a pathological type of Budd-Chiari syndrome); thrombosis of the portal vein or prehepatic portal hypertension because of cavernous transformation; intrahepatic portal hypertension with rebleeding after splenectomy or non-operation, and those patients with liver function in grade A or B according to the Child-Pugh classification.