The Interventional Therapy Of Budd-Chiari Syndrome

Objective: To study pathophysiology, pathology, imageology,the choice and curative effective analysis of the interventional therapy of the all types of Budd-Chiari syndrome (BCS).Methods: Making a reviewing analysis of 36 cases with BCS were final diagnosised by inferior vena cavography,Doppler ultrasound and operation, in which men 20 cases, women 16 cases, 36.4士5.8 years old in average, course of disease is 18 days to 25 years. Clinical symptom and signs include: abdominal distention(12 cases), short breath or debilitation (20 cases), augmentation of liver volume(18 cases), augmentation of spleen volume(7 cases), acting out of subcutaneous varicos vein of abdominal wall(13 cases), abdominal dropsy(16 cases), Edema of lower extremities(21 cases), skin pigment of lower extremity(2 cases), upper gastrointestinal bleeding(1 case). Contrast examination of Doppler ultrasound and angiography showed that IVC hepat-posterior segment membrane angusty(18 cases), hepat-posterior segment membrane obliteration(2 cases), S-T segmental angusty(10 cases), S-T segmental obliteration (6 cases). According to Sugiur typing, 18 cases of typeⅠa operated by IVC PTA; 3 cases of typeⅠb by operated by HV+IVC PTA or PTA+SPV;5 cases of typeⅡoperated by IVC, PTA or PTA+SPV; 1 case of typeⅢoperated by IVC, PTA or PTA+SPV; 8 cases of typeⅣoperated by HV PTA.Results: In the group, except for 1 cases with hepat-posterior segment thecate obliteration, IVC, IVC S-T segmental stenosis, 3 rami HV obliteration without deoppilation, 35 cases were operated by PTA OR PTA + SPV successfully. 28 cases were operated by PTA, 7 cases were operated by PTA+SPV after PTA. The bloodstreams of the patients in the the 35 cases transited well through the choke sects after the operations. 72 hours after operations, patients'short breath, debilitation and abdominal distention had obvious amelioration: subcutaneous varicos vein of abdominal wall extincted gradually, abdominal dropsy decreased, Edema of both lower extremities resolved and cubic capacity of liver and spleen deflated. The signs and symptoms of patients of 27cases after operation relieved or vanished quickly within 72 hours; 6 cases'signs and symptoms had fract improvement after operation; 2 cases did not have obvious improvement. None of the cases emerged into serious complications of mispricking camera cordis or lung embolism. Giving antibiotic treatment to patients for 1 week to prevent infection. Meanwhile, making hypodermic injection of calparine for 3-5 days; dextran-40 injection for 5-7 days; oral administration of acenterine for 6 months. Rechecking the plain abdominal radiograph 1 week after the operation to comprehend the expanding condition of the stent and its aversion. Doing ultrasonic inspection after operation to comprehend the the dredging clear state of inferior vena. There are three kinds of appreciation of the curative effect after operations:①completely raised, which means symptoms and signs, disappeared totally. (Affected blood vessel having no recovery).②partially raised, which means symptoms and signs, improved partially. (Affected blood vessel having partially recovery, but did not influence the normal flowing of blood current).③Ineffective. (the appearance of restenosis).The pressure gradient of affected remote and proximal part vein changed remarkably after interventional therapy of each kind of BCS(P<0.01).Statistic treatment: The statistics of pressure gradient of remote and proximal part between inferior vena and hepatic venous obstruction of before and after operations were treated with rank sum test (SPSS10.0). There was significant deviation of the changes of pressure gradient of remote and proximal part of the BCS before and after the operations(F=4.68,P<0.01).Conclusions:①Interventional therapy is the best healing method of BCS. It is recommended of the embedding of stent if the therapeutic effect of dilatation of saccule is not good. The choice of stent should base on the IVC stenosis length and diameter of the patients'. It should be 10% larger than the diameter of normal IVC.②The healing of BCS should be drafted out compatible individual schedule according to clinic pathotype. Any modus operandi that can anastate physiology recirculating channel and degrade the pressure of obliterate distant vein was effective of healing of BCS.③The pressure gradient of affected remote and proximal part vein degraded more than 10mmHg after Interventional therapy. The amelioration of symptom was more obvious and the possibility of recidivation after operation degraded. The degradation of the pressure gradient of affected remote and proximal part vein after operation was less than 8mmHg mean that the amelioration of patients'physical signs and symptoms were not obvious and recurrence rate was high.