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 .

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 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 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 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 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 investigate the causes,prevention and management principles of postoperative recurrence of Budd Chiari syndrome(BCS).Methods The clinical data of 223 postoperative recurrence BCS patients were analyzed retrospectively,including type Ia in 66 cases,type Ib in 48 cases,type II in 57 cases , type IIIa in 28 cases,and type IIIb in 24 cases. Of them,36 patients underwent two or more operations .Results Secondary operations were all successful.No patient died in the perioperative period. One hundred and eighty two patients were followed up for 6 months to 10 years.In 89.6% of the patients,the results were successful,but the recurrence rate after the reoperation was 6.0%,and 8 patients died postoperatively .Conclusions The main recurrent causes are that indications are not correctly selected and the operative technique is not correct. Correct classification,reasonable selection of the operation method, and adopting an interruptive,matress,and eversive suture for blood vessels anastomosis in the operation are important to prevent the recurrence of BCS.

Objective To investigate the diagnosis and treatment of portal hypertension caused by cavernous transformation of the portal vein (CTPV) in adults Methods A retrospective study was made on clinical data of 31 adult upper GI bleeding patients with CTPV The diagnosis of CTPV in all cases were confirmed by B ultrasonography or ultrasonic Doppler and by percutaneous splenoportography or selective arteriography Splenic artery and coronary vein ligation plus C graft mesocaval shunt was performed in 12 cases Splenorenal graft shunt was performed in 1 In 8 post splenectomy rebleeding, cases 6 underwent C graft mesocaval shunt, one inferior meso caval shunt and one jejunectomy due to ictopic variceal hemorrhage Six cases received splenocaval shunt 2 splenopneumopexy 1 splenorenal shunt 1 portocaval shunt 1 pericardial devascularization ResultsPostoperativelly varices disappeared or ameliorated in all patients There was no rebleeding and hepatoencephalopathy occurred in follow up of 6 months to 4 years Conclusion Ultrasonic Doppler and percutaneous splenoportography are diagnostic for CTPV in adults Portasystemic shunt plus porta azygous devascularization is the choice of treatment

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.