Interventional Therapy for Budd-Chiari Syndrome Secondary to Hepatic Venous Obstruction with 8-Year Follow-Up_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 DINGPeng-xu ¹ ,  ZHANGShui-jun ² , LIZhen ¹ , FUMing-ti ¹ , HUAZhao-hui ¹ , ZHANGWen-guang ¹ , WANGZhong-gao ^1,3,4

1. Department of Endovascular Surgery, The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, Henan Province, China;
2. Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, Henan Province, China;
3. Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China;
4. Department of Vascular Surgery, The Second Artillery General Hospital of Chinese People's Liberation Army, Beijing 100088, China;

Corresponding author：

ZHANGShui-jun, Email: zhangshuijun@zzu.edu.cn

Keywords：

Budd-Chiari syndrome; Hepatic vein; Percutaneous transluminal angioplasty; Effect

DOI：

10.7507/1007-9424.20140356

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Objective To evaluate the applicability and the long-term outcomes of percutaneous transluminal balloon angioplasty (PTBA) in the management of Budd-Chiari syndrome (BCS) secondary to hepatic venous obstruction. Methods Clinical data of 94 patients with BCS secondary to hepatic venous obstruction who underwent PTBA of the hepatic vein from Jan. 2005 to Dec. 2013 in The First Affiliated Hospital of Zhengzhou University were analyzed retrospectively. Results PTBA were technically successful in 93 of the 94 patients (98.94%). Ninety-one of the 93 patients (97.85%) were treated with PTBA alone and 2 patients (2.15%) were treated with PTBA and stent. One patient with primary hepatocellular carcinoma (HCC) underwent resection of liver cancer after interventional therapy. Hepatic venous pressure value of 93 patients was significantly decreased after balloon interventional procedures. Symptoms were significantly improved in the 93 patients who had successful PTBA. Procedure-related complications occurred in 6 of the 93 patients (6.38%), and 1 patient (1.06%) died in 2 months after operation because of intra-abdominal bleeding. Two patients lost during follow-up with a follow-up loss rate of 2.15% (2/93), and the 91 patients were followed-up for 1-96 months [(49.72±28.60) months]. HCC occurred in 3 patients during follow-up period. Restenosis of targeted hepatic vein developed in 8 patients (11 times), and the overall recurrence rate was 11.83% (11/93). One patient of them underwent surgical operation, the remaining 7 patients underwent PTBA successfully. The 1-, 2-, 3-, and 5-year primary patency rates were 97.47% (77/79), 94.20% (65/69), 91.67% (55/60), and 91.67% (33/36), respectively. The 1-, 2-, 3-, and 5-year secondary patency rates were 98.73% (78/79), 98.55% (68/69), 98.33% (59/60), and 97.22% (35/36), respectively. Conclusions PTBA is a safe and effective treatment for BCS with the hepatic vein obstruction and had good mild-term outcomes. The liver function of the patients improved after treatment, with few patients died from HCC caused by hepatic cirrhosis, so we must pay attention on it, as well as the targeted hepatic vein.

Citation： DINGPeng-xu, ZHANGShui-jun, LIZhen, FUMing-ti, HUAZhao-hui, ZHANGWen-guang, WANGZhong-gao. Interventional Therapy for Budd-Chiari Syndrome Secondary to Hepatic Venous Obstruction with 8-Year Follow-Up. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(12): 1500-1506. doi: 10.7507/1007-9424.20140356 Copy

1.	李彦豪, 陈勇.介入治疗技术在Budd-Chiari综合征治疗中的地位[J].实用医学杂志, 2000, 16(5):350-351.
2.	祖茂衡.Budd-Chiari综合征的影像综合诊断与介入治疗[J].中国医学计算机成像杂志, 2002, 8(2):108-115.
3.	韩新巍, 丁鹏绪, 吴刚.布加综合征下腔静脉阻塞直径30 mm大球囊扩张的可行性研究[J].介入放射学杂志, 2008, 17(4):243-246.
4.	张希全, 刘海军, 鹿咏红, 等.经皮经肝穿刺门静脉行胃底食管曲张静脉栓塞术治疗上消化道出血[J].中华普通外科杂志, 2005, 20(4):218-220.
5.	肖绍树, 周学斌.部分脾栓塞治疗肝硬化门脉高压症和脾功能亢进的研究进展[J].实用肝脏病杂志, 2006, 9(3):183-184.
6.	韩新巍, 李永东.布-加综合征介入治疗技术操作规范的几点建议[J].介入放射学杂志, 2002, 11(4):316-318.
7.	Klein AS.Management of Budd-Chiari syndrome[J].Liver Transpl, 2006, 12(11 Suppl 2):S23-S28.
8.	Qiao T, Liu CJ, Liu C, et al.Interventional endovascular treatment for Budd-Chiari syndrome with long-term follow-up[J].Swiss Med Wkly, 2005, 135(21-22):318-326.
9.	成德雷, 徐浩, 华荣, 等.原发性布加综合征的病因及临床特征研究[J].中华肝脏病杂志, 2013, 21(11):850-854.
10.	张曦彤, 徐克, 祖茂衡, 等.Budd-Chiari综合征肝静脉闭塞的介入治疗[J].中华放射学杂志, 2003, 37(5):449-453.
11.	Patil P, Deshmukh H, Popat B, et al.Spectrum of imaging in Budd Chiari syndrome[J].J Med Imaging Radiat Oncol, 2012, 56(1):75-83.
12.	韩新巍, 丁鹏绪, 刘冰妍, 等.Budd-Chiari综合征:国人病变肝静脉分布的影像学研究[J].临床放射学杂志, 2009, 28(2):201-204.
13.	韩新巍, 徐克, 祖茂衡, 等.布-加综合征介入治疗与研究进展[M].郑州:郑州大学出版社, 2010:200-210.
14.	祖茂衡.布-加综合征的影像诊断与介入治疗[M].北京:科学出版社, 2004:256-265.
15.	祖茂衡, 徐浩, 顾玉明, 等.布-加综合征介入治疗——导丝贯穿法行下腔静脉和肝静脉成形术[J].介入放射学杂志, 2006, 15(9):521-523.
16.	Li TX, Zhai ST, Pang ZG, et al.Feasibility and midterm outcomes of percutaneous transhepatic balloon angioplasty for symptomatic Budd-Chiari syndrome secondary to hepatic venous obstruction[J].J Vasc Surg, 2009, 50(5):1079-1084.
17.	李金保, 权晖, 薛克, 等.经皮胃冠状静脉栓塞术后预防肝穿刺道出血的方法探讨[J].介入放射学杂志, 2014, 23(1):73-75.
18.	李征然, 单鸿, 朱康顺, 等.肝静脉型Budd-Chiari综合征的介入治疗[J].介入放射学杂志, 2004, 13(1):25-27.
19.	祖茂衡.布-加综合征的影像诊断与介入治疗[M].北京:科学出版社, 2004:324-327.
20.	孙振阳, 芮清峰, 刘允乐.38例肝静脉膜型布加综合征诊治分析[J].安徽医药, 2013, 17(5):795-796.
21.	Rautou PE, Douarin L, Denninger MH, et al.Bleeding in patients with Budd-Chiari syndrome[J].J Hepatol, 2011, 54(1):56-63.
22.	Kawaguchi T, Sata M, Ono N, et al.Budd-Chiari syndrome complicated by hepatocellular carcinoma with no evidence of infection with hepatitis virus:a case report[J].Hepatogastroenterology, 1999, 46(30):3237-3240.
23.	Vilgrain V, Lewin M, Vons C, et al.Hepatic nodules in Budd-Chiari syndrome:imaging features[J].Radiology, 1999, 210(2):443-450.
24.	Liu FY, Wang MQ, Duan F, et al.Hepatocellular carcinoma associated with Budd-Chiari syndrome:imaging features and transcatheter arterial chemoembolization[J].BMC Gastroenterol, 2013, 13:105.
25.	Aoki K, Miyamoto T, Murata H, et al.Significance of accessory hepatic venography to evaluate the intrahepatic venous system for obstruction of the inferior vena cava at the hepatic portion with main hepatic vein obstruction[J].Nihon Geka Gakkai Zasshi, 1986, 87(6):704.
26.	Simson IW.Membranous obstruction of the inferior vena cava and hepatocellular carcinoma in South Africa[J].Gastroenterology, 1982, 82(2):171-178.
27.	Dilawari JB, Bambery P, Chawla Y, et al.Hepatic outflow obst-ruction (Budd-Chiari syndrome).Experience with 177 patients and a review of the literature[J].Medicine (Baltimore), 1994, 73(1):21-36.
28.	Valla DC.Primary Budd-Chiari syndrome[J].J Hepatol, 2009, 50(1):195-203.
29.	Chen MF, Hwang TL, Jeng LB, et al.Postoperative recurrence of hepatocellular carcinoma.Two hundred five consecutive pati-ents who underwent hepatic resection in 15 years[J].Arch Surg, 1994, 129(7):738-742.

1. 李彦豪, 陈勇.介入治疗技术在Budd-Chiari综合征治疗中的地位[J].实用医学杂志, 2000, 16(5):350-351.
2. 祖茂衡.Budd-Chiari综合征的影像综合诊断与介入治疗[J].中国医学计算机成像杂志, 2002, 8(2):108-115.
3. 韩新巍, 丁鹏绪, 吴刚.布加综合征下腔静脉阻塞直径30 mm大球囊扩张的可行性研究[J].介入放射学杂志, 2008, 17(4):243-246.
4. 张希全, 刘海军, 鹿咏红, 等.经皮经肝穿刺门静脉行胃底食管曲张静脉栓塞术治疗上消化道出血[J].中华普通外科杂志, 2005, 20(4):218-220.
5. 肖绍树, 周学斌.部分脾栓塞治疗肝硬化门脉高压症和脾功能亢进的研究进展[J].实用肝脏病杂志, 2006, 9(3):183-184.
6. 韩新巍, 李永东.布-加综合征介入治疗技术操作规范的几点建议[J].介入放射学杂志, 2002, 11(4):316-318.
7. Klein AS.Management of Budd-Chiari syndrome[J].Liver Transpl, 2006, 12(11 Suppl 2):S23-S28.
8. Qiao T, Liu CJ, Liu C, et al.Interventional endovascular treatment for Budd-Chiari syndrome with long-term follow-up[J].Swiss Med Wkly, 2005, 135(21-22):318-326.
9. 成德雷, 徐浩, 华荣, 等.原发性布加综合征的病因及临床特征研究[J].中华肝脏病杂志, 2013, 21(11):850-854.
10. 张曦彤, 徐克, 祖茂衡, 等.Budd-Chiari综合征肝静脉闭塞的介入治疗[J].中华放射学杂志, 2003, 37(5):449-453.
11. Patil P, Deshmukh H, Popat B, et al.Spectrum of imaging in Budd Chiari syndrome[J].J Med Imaging Radiat Oncol, 2012, 56(1):75-83.
12. 韩新巍, 丁鹏绪, 刘冰妍, 等.Budd-Chiari综合征:国人病变肝静脉分布的影像学研究[J].临床放射学杂志, 2009, 28(2):201-204.
13. 韩新巍, 徐克, 祖茂衡, 等.布-加综合征介入治疗与研究进展[M].郑州:郑州大学出版社, 2010:200-210.
14. 祖茂衡.布-加综合征的影像诊断与介入治疗[M].北京:科学出版社, 2004:256-265.
15. 祖茂衡, 徐浩, 顾玉明, 等.布-加综合征介入治疗——导丝贯穿法行下腔静脉和肝静脉成形术[J].介入放射学杂志, 2006, 15(9):521-523.
16. Li TX, Zhai ST, Pang ZG, et al.Feasibility and midterm outcomes of percutaneous transhepatic balloon angioplasty for symptomatic Budd-Chiari syndrome secondary to hepatic venous obstruction[J].J Vasc Surg, 2009, 50(5):1079-1084.
17. 李金保, 权晖, 薛克, 等.经皮胃冠状静脉栓塞术后预防肝穿刺道出血的方法探讨[J].介入放射学杂志, 2014, 23(1):73-75.
18. 李征然, 单鸿, 朱康顺, 等.肝静脉型Budd-Chiari综合征的介入治疗[J].介入放射学杂志, 2004, 13(1):25-27.
19. 祖茂衡.布-加综合征的影像诊断与介入治疗[M].北京:科学出版社, 2004:324-327.
20. 孙振阳, 芮清峰, 刘允乐.38例肝静脉膜型布加综合征诊治分析[J].安徽医药, 2013, 17(5):795-796.
21. Rautou PE, Douarin L, Denninger MH, et al.Bleeding in patients with Budd-Chiari syndrome[J].J Hepatol, 2011, 54(1):56-63.
22. Kawaguchi T, Sata M, Ono N, et al.Budd-Chiari syndrome complicated by hepatocellular carcinoma with no evidence of infection with hepatitis virus:a case report[J].Hepatogastroenterology, 1999, 46(30):3237-3240.
23. Vilgrain V, Lewin M, Vons C, et al.Hepatic nodules in Budd-Chiari syndrome:imaging features[J].Radiology, 1999, 210(2):443-450.
24. Liu FY, Wang MQ, Duan F, et al.Hepatocellular carcinoma associated with Budd-Chiari syndrome:imaging features and transcatheter arterial chemoembolization[J].BMC Gastroenterol, 2013, 13:105.
25. Aoki K, Miyamoto T, Murata H, et al.Significance of accessory hepatic venography to evaluate the intrahepatic venous system for obstruction of the inferior vena cava at the hepatic portion with main hepatic vein obstruction[J].Nihon Geka Gakkai Zasshi, 1986, 87(6):704.
26. Simson IW.Membranous obstruction of the inferior vena cava and hepatocellular carcinoma in South Africa[J].Gastroenterology, 1982, 82(2):171-178.
27. Dilawari JB, Bambery P, Chawla Y, et al.Hepatic outflow obst-ruction (Budd-Chiari syndrome).Experience with 177 patients and a review of the literature[J].Medicine (Baltimore), 1994, 73(1):21-36.
28. Valla DC.Primary Budd-Chiari syndrome[J].J Hepatol, 2009, 50(1):195-203.
29. Chen MF, Hwang TL, Jeng LB, et al.Postoperative recurrence of hepatocellular carcinoma.Two hundred five consecutive pati-ents who underwent hepatic resection in 15 years[J].Arch Surg, 1994, 129(7):738-742.

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Interventional Therapy for Budd-Chiari Syndrome Secondary to Hepatic Venous Obstruction with 8-Year Follow-Up

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