| Objective:To summarize clinical manifestations and diagnostic measures of the Budd-Chiari syndrome(Budd-Chiari syndrome, BCS), and then evaluate its long-term efficacy after treated by percutaneous angioplasty.Materials and Methods:A retrospective review of 75 patients with BCS after treated by percutaneous angioplasty from January 1999 to January 2015 in the First Affiliated Hospital of Nanchang University hospital. Analysis of clinical symptoms, the amount of time from diagnosis to treatment, and methods of treatment, and then keeping on a long-term follow-up. The end point of follow-up is 10 years, or the patients died, or January 2015. The Kaplan-Meier curves were used to analyze initial cumulative patency rates and survival rates of surgery. The COX regression model was applied to determine the univariate and multivariate factor of survival.Results:1. General: All 75 patients with BCS(32 were male, 43 were female; age was from 12 to 70 years, mean age was 42.05 ± 12.59 years). 95% of patients(71/75)succeeded in treatment with percutaneous revascularization(median was 39 months).All patients come from Jiangxi province.2. Clinical symptoms and signs: 51% of patients(38/75) were cirrhosis. The constituent ratio of incipient symptoms was including abdominal pain 75%(56/75),abdominal distension 85%(64/75), ascites 63%(47/75), swelling of the liver 47%(35/75), refractory ascites 5%(4/75), trunk varices 5%(4/75), gastrointestinal bleeding 11%(8/75), lower limb edema 25%(19/75), lower extremity pigmentation8%(6/75), hematuria 1%(1/75), infertility 1%(1/75).3. The enduring time from BCS onset to treatment: the shortest time was one month, and the longest history was 360 months(average was 32.47 ± 56.19 months, median was 12 months). 79% of patients(59/75) were chronic BCS, but 21%(16/75)were acute or subacute BCS.4. Imaging: IVC disease 76%(57/75), hepatic venous lesions 17%(13/75),mixed 6%(5/75). The diagnosis rate of Color Doppler ultrasound was 93%, and computed tomography(CT) was 60%, showing significant differences between two groups [P = 0.001(Fisher’s exact test)].5. Classification and treatment: Ia type 49%(37/75), Ib type 23%(17/75), IIa type 1%(1/75), IIb type 3%(2/75), IIIa type 16%(12/75), IIIb type 1%(1/75), IVa type 1%(1/75), IVb type 5%(4/75).95% of patients succeeded in repatency, including IVC type 96%(55/57),HV-type 84%(11/13), mixed type 100%(5/5). As for BCS treatment, PTA 69%(49/71), PTA in combination with stent 31%(22/71).Preoperative inferior vena cava pressure was(32.3 ± 3.1) cm H2 O, postoperative inferior vena cava pressure was(11.8 ± 2.1) cm H2 O. Postoperative remission rate,including abdominal pain 98%(55/56), abdominal distension 95%(61/64), ascites96%(45/47), hepatomegaly 100%(35/35), refractory ascites 50%(2/4), trunk varices100%(4/4), gastrointestinal bleeding 88%(7/8), lower limb edema 100%(19/19),lower extremity pigmentation 100%(6/6), hematuria 100 %(1/1), infertility 100%(1/1).6. Patency: 16 patients with re-occlusion after 10 years, including 15 of 49 in PTA alone(re-occlusion rate was 31%); 1 of 22 in PTA in combination of stent(re-occlusion rate of 5 %), that was a significant difference between two groups, P<0.04. The Cumulative patency rate of 1 year, 5 years, 10 years were 95%, 80%,63%.7. Survival: Cumulative survival rate of 1 year, 5 years and 10 years were 95%,83%, 69%. PTA alone of 1 year, 5 years and 10 years were 94%, 77%, 59%; PTA in combination of stent of 1 year, 5 years and 10 years were 100%, 85%, 68%. The Log-rank test between the two groups is X2 = 0.36, P = 0.55, and the difference between the two groups was not statistically significant.8. The related factors of death: Univariate analysis of the related factors of death is bleeding esophageal varices, re-occlusion, Child-Pugh score, alanine aminotransferase base, aspartate aminotransferase, alkaline phosphatase, total bilirubin, urea nitrogen. Multivariate analysis is esophageal variceal bleeding,alkaline phosphatase, blood urea nitrogen, re-occlusion.Conclusion:1. The principal treatment of patients with Budd-Chiari syndrome was PTA.PTA in combination with stent prevents more effectively from re-occlusion rate.2. Angioplasty in combination with TIPS surgery relieve more effectively portal hypertension for the patients with Budd-Chiari syndrome complicated with cirrhosis and portal hypertension. |
