ObjectiveTo explore the best therapy for the treatment of membranous Budd-Chiari syndrome.MethodsThe surgical result of 480 cases with membranous Budd-Chiari syndrome was analysed retrospectively.ResultsCases of Kimura′s finger rupture, interventional treatment and membrane resection were followed up, with follow-up rates of 84.62%, 86.55% and 87.37% respectively, with effective rates of 61.4%, 91.7% and 90.4% respectively, recurrence rates of 38.6%, 8.3% and 9.6% respectively. The long-term effect of interventional treatment and resection was significantly better than Kimura′s finger rupture(P

Objective To discuss the experiences of surgical treatment of hepatic cavernous hemangioma in a peculiar position. Methods We retrospectively analyzed the clinical data of 32 cases of cavernous hemangioma in the central area of the liver. Results All of the hepatic cavernous hemangiomas were resected successfully by extracapsular dissection. Intraoperative hemorrhage volume varied from 50ml to 10000ml, and in 12 patients the amount of blood transfusion was 400ml to 4000ml. 5 cases (15.6%) had postoperative complications, including right pleural effusion(3 cases), bile leakage(1 case), and subdiaphragmatic fluid collection(1 case). The mortality rate was 3.1%(1/32). 26 cases were followed up for a median of(3.09?0.93)yrs, and there was no recurrence of hemangioma. Conclusions Familiarity with the liver anatomy and proficient operative methods are the key get to successful surgical treatment of these hemangiomas and reduce complications. Extracapsular dissection is a safe and effective way to treat hepatic cavernous hemangioma .

Objective To set up CEAP system for the diagnosis of portal hypertention.Methods Based on CEAP system from American Venous Forum,the clinical and pathologic classification of Budd-Chiari syndrome from Xu,the clinical and pathologic data of 251 cases of portal hypertension were analyzed retrospectively.Results According to the results of imaging examination [(Doppler ultrasound,percutaneous splenoportography,selective angiography of mesenteric artery,multi-slice spiral CT(MSCT) three dimensional(3D) reconstruction],clinical and pathological data,CEAP system for the diagnosis of portal hypertention was defined as follows: Clinical manifestation(C) including mild and severe types;Etiology(E)(congenital,primary,secondary);Anatomy(A) consists of liver,inferior vena cava,hepatic veins,and portal vein system;Pathophysiology(P) could have liver fibrosis/cirrhosis,obstruction,thrombosis,intrahepatic collateral circulation and tumors.Conclusions CEAP system for correct diagnosis,classification as well as the individual treatment is of great practical importance,and could be wide application.

Objective To investigate the indications for interventional therapy of Budd-Chiari syndrome((B-CS)) and surgical treatment after stent failure. Methods A retrospective analysis of the clinical data of 21 patients with mistakes in treatment of B-CS by stent placement in inferior vena cava(IVC).Results (Among) the 21 cases with mistakes, the indications were inappropriately selected in 6 cases, the main hepatic vein was obstructed by the stent in 1 case, dilated accessory veins were occluded in 10 cases, the stent was (displaced) in 3 cases, and the stent failed to unfold in 1 case. Nineteen cases were converted to operation; of these patients, a shunt was performed in 18 cases, and radical excision of diaphragmatic web of IVC was done in 1 case. Operation was successful in all 19 cases. After shunt procedure in the 18 cases, the free portal pressure significantly decreased(P

Objective　To study the mechanism and management of abdominal compartment syndrome (ACS) in patients with Budd Chiari Syndrome (BCS).Methods　42 patients with BCS complicated with ACS were diagnosed by venography and intraabdominal pressure measurement. All patients were treated with ascities dialysis and influsion before operation. Portosystemic shunt was performed on 36 patients, and interventional procedures were conducted to recanalize the occluded main hepatic vein(MHV) on 6 patients. Results　In this series, 2 patients died postoperatively and 2 patients had no good results in long term follow-up; the clinical features disappeared or markedly alleviated in the others. Conclusions　MHV occlusion is the primary pathologic change of BCS complicated with ACS. Portosystemic shunt operation or MHV recanalization by interventional therapy can relieve the symptoms of BCS with ACS.

Objective To study the mechanism and management of abdominal compartment syndrome (ACS) in patients with Budd Chiari Syndrome (BCS).Methods 42 patients with BCS complicated with ACS were diagnosed by venography and intraabdominal pressure measurement. All patients were treated with ascities dialysis and influsion before operation. Portosystemic shunt was performed on 36 patients, and interventional procedures were conducted to recanalize the occluded main hepatic vein(MHV) on 6 patients. Results In this series, 2 patients died postoperatively and 2 patients had no good results in long term follow-up; the clinical features disappeared or markedly alleviated in the others. Conclusions MHV occlusion is the primary pathologic change of BCS complicated with ACS. Portosystemic shunt operation or MHV recanalization by interventional therapy can relieve the symptoms of BCS with ACS.

Objective To study a new operative method for treatment of hepatic venous occlasion without (associated) pathologic change of inferior vena cava or long-segment stricture. Methods A total of 44 cases of Budd-chiari syndrome with hepatic venous occlusion without pathologic change or long-segment stricture of (inferior) vena cava underwent combined mesocaval C-shunt, ligation of splenic artery, and esophagogastric (devascularization).Results Pre-shunt portal venous pressure was 36cmH2O(31~45 cmH2O, 1cmH2O=0.0098kPa) and post-shunt pressure fell to 26 cmH2O(21~33 cmH2O),the mean reduction was 10 cmH2O. One patient died of liver failure. A slight degree of hepatic encephalopathy occurred in 2patients who recovered after conservative treatment.Chylorrhea occurred in 4 patients, and it spontaneously disappeared 7d to 3.5months after operation. 39 patients(88.6% follow up) were followed up for 6months to 7years , and there was no case of recurrent bleeding nor hepatic encephalopathy. Ascites disappeared in 31cases,and was markedly reduced in 7 cases .The prosthetic grafts were patent as shown by color Doppler ultra sound in all followed-up patients.Conclusions This operation is simple and effective for B-CS with hepatic venous (occlusion) but not associated with inferior vena caval pathologic change or long-segment stricture.

Objective To investigate the treatment of severe Budd-Chiari syndrome (BCS) . Methods The clinical data of 95 patients with severe BCS from November 1994 to June 1999 were retrospectively analyzed . Results Mesocaval C shunt with artificial graft was performed in 51 cases , splenojugular shunt with artificial graft in 23 cases ,mesojuglar shunt with artificial graft in l case , percutaneous transhepatic recanalization and dilation and/or stent placement of main hepatic vein (MHV) in 10 case, and combined PTA and stent placement of inferior vena cava (IVC) and mesocaval shunt in 10 cases . 5～60 months follow-up showed excellent result in 65 patients , good results in 25 and 5 cases dead. Conclusions Good results could be obtained by most of the severe BCS patients treated by different procedures according to the pathological changes of IVC and main hepatic vein.

Objective To investigate the indication,feasibility and clinical effectiveness of stage management of Budd-Chiari syndrome(B-CS). Methods From Feb 2007 to June 2009,32 cases of Budd-Chiari syndrome(9 cases of type Ⅰ,17 cases of type Ⅲa,6 cases of type Ⅲ b)were admitted.Inferior vena cava hypertension(IVCHT)and portal hypertension(PHT)co-existed in all the patients.According to the clinicopathologic classification and hemodynamic compensation,these patients underwent single stage treatment(snrglcal procedure or radioactive intervention)or two-stage management(one.stagesurgical procedure/radioactive intervention plus two-stage surgical procedure/radioactive intervemion).Results Recovery was achieved in all patients without mortality.The main complications were Dleural effusion in 3 cases,acute heart failure in 2 cases and celiac lymphatic leakage in 1 case respectively.which were cured after medical treatment.In 4 months to 2 years follow-up,no recurrent cases were identified and all the patients were in good condition. Condusions Stage management of Budd.Chiari svndrome canalleviate the perioperative risk and clinical effectiveness can be achieved.The hemodynamic compensation is the basis on which stage management is adopted.

Objective To study the effect of small diameter graft (0.8 cm) splenocaval or mesocaval shunts combined with pericardial devascularization in the treatment of portal hypertensive variceal bleeding. Methods Splenocaval shunts were performed in 14 patients and mesocaval shunts were done in 24 patients, in combination with pericardial devascularization. Results The average decrease of free portal pressure was 6.6±1.2 cm. There was no significant changes in liver function postoperatively (P>0.05). Platelet counts and leukocyte counts were back to normal in splenocaval shunt patients postoperatively (P< 0.05). Operative mortality was 3%. Pyrexia developed in 4 patients, intractable ascites in 1 patient, chylons ascites in 1 patient, hepatic encephalopathy in 1 patient, intraabdominal infection in 1 patient and stress ulceration in 1 patient. All patients recovered after expectant treatment except one who died from severe intraabdominal infection. 35 patients received follow-up between 6 months and 3 years, total effective rate was 89%, 2 patients died from recurrent variceal bleeding, the shunt potency rate was 80% in 1 year and 75% in 3 years. Esophagogastric varices disappeared or alleviated as shown by endoscopy in 25 patients on 6 months postoperatively. Conclusions Small diameter portosystemic graft shunts combined with poricardial devascularization is an effective therapy for bleeding esophagogastric varices with a low rate of hepatic encephalopathy. Splenocaval shunt alleviates hypersplenism concurrently.