Evaluation To Influential Factors Of The Surgical Treatment Effects For Budd-chiari Syndrome

BackgroundBudd-Chiari syndrome (B-CS) presents the portal hypertension and/or inferior vela cava (IVC) hypertension which is caused by the outlet occlusion of hepatic veins (HV) and/or IVC. Since George Budd and Hans Chiari reported such cases individually, more than one hundred years had past. Due to the enhancement of diagnostic and therapeutic technique, a large amount cases were reported. Overviewed the domestic references, over 4,000 patients were diagnosed and treated. Some papers indicated that Japan, India and South Africa are the regions with high-incidence rate, as well as Henan, Shandong and Anhui provinces in China. B-CS often occurred in younger population, and the nature prognosis was poor, the internal medicine treatment usually without use. Because the complicated condition and varied pathologic types, the therapeutic choice of such patient was also very tough. Aimless and unconditional treatment of intervention and operation would increase the recurrence rate and the difficulties of further therapy. Recent years, most researches focused on the etiology and therapy, few papers on the global evaluation of therapeutic effects. In this research, we analyzed the data of 86 postoperative cases retrospectively, such as the age, sex, process, pathologic type, operative method, hepatocirrhosis, secondary operation, operative complication and application of anticoagulation, and we also took the operative effects and follow-up (effective and recurrence rate) into consideration. So we could explore the main influential factors to surgical treatment, and provide the theory basis for choosing reasonable treatment methods.Materials and methodsIn B-CS group, there were 86 cases, male, 47; female, 39. From 18 to 48, average 34.67±9.28. According to the Xu Peiqin typing, type I a 16 cases, type I b 28 cases, type Ⅱ 24 cases, type Ⅲa 12 cases, type Ⅲb 6 cases, Surgical treatment methods including: splenopneumopexy 20 cases; radical resection of membrane and thrombus 12 cases; inferior vena cava(IVC)bypass 18 cases; mesocaval C-shape shunt 18 cases; Splenocaval shunt 2 cases; splenojugular shunt 4 cases; splenorenal shunt 2 cases. In control, 78 cases, male 43; female, 35. From 20 to 47, average 34.85±8.92. All came from the same hospitalized period, non-hepatic and non-vessel operative patients, there were no significance between the two groups in age, sex, height and weight. Nine indications were under the investigation, including age, sex, progress, pathologic type, operative method, hepatocirrhosis and complication. The influence and impactive degree arisen from the indications to the operative effects, the total effectiveness and the recurrence rate were analyzed, and compared to the control, to discuss the way to decrease the recurrence and to increase the effectiveness. Follow-up were performed by telephones and letters. Statistics were dealt with by SSPS10.0 software package.Results1. The mortality of B-CS group was 2.33% (2/86), incidence of complication was 9.30% (8/86), the total effectiveness was 95.35% (82/86).2. In B-CS group, one or five years after operation, the effective rate was 92.86% (78/84) and 87.18% (68/78) , the recurrenc e rate was 7.14% (6/84) and 12.82% (10/78) . Six patients died, including two patients died with hepatic encephalopathy,one died with upper gastrointestinal hemorrhage 5 years after operation, 1 died with hepatic carcinoma after operation, 2 died with renal failure after operation.3. The single factor which would influence the operative effect was process, hepatocirrhosis, complication, pathological type and operation methods (p<0.05).4. The single factor which would influence the postoperative effect and recurrence was process, hepatocirrhosis, complication (severe B-CS or not), pathological type, operative method and postoperative anticoagulation (p<0.05).5. The multiple factors which would influence the surgical effect were process, pathological type, hepatocirrhosis, operative method, secondary operation and postoperative anticoagulation or not, it was significant for the relations of thesefactors to postoperative effect and recurrence.Conclusions1. It seems that correct diagnose, proper preoperative treatment, counterpart operative method for different type and postoperative anticoagulation will reduce the operative mortality, postoperative complication and recurrence, as well as increase the curative rate.2. The disease process, pathological type, hepatocirrhosis, operative method, secondary operation or not and postoperative coagulation are high risk factors interfering the surgical effects of B-CS.