Effect of Venous Retransfusion of Ascites on Treatment of Complicated Patients with Budd-Chiari Syndrome_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Zhen ¹ , WANG Zhonggao ^1,2 , HUO Xiaosen ¹ , WANG Leiyong ¹ , JI Feng ¹ , BIAN Ce ³

1.Department of Vascular Surgery, General Hospital of Chinese Aviation, Beijing 100012, China;;
2.Department of Vascular Surgery, Xuanwu Hospital, Capital University of Medical Science, Beijing 100053, China;;
3.Department of Thoracic and Cardiovascular Surgery, The Second Artillery General Hospital, Beijing 100088, China;

Corresponding author：

Keywords：

Budd-Chiari syndrome; Ascites; Vein; Retransfusion; Denver shunt

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Objective To explore the methods and effect of venous retransfusion of ascites on the treatment of the complicated patients with Budd-Chiari syndrome.
Methods Eighteen complicated and (or) recrudescent patients with Budd-Chiari syndrome were treated by venous retransfusion of ascites between March 2006 and July 2009. The changes in abdominal girth, body weight, the urine volume of 24 h, liver function, renal function, and serum electrolyte measurements before and after treatment were compared.
Results After retransfusion of 5 000 ml to 7 800 ml (mean 6 940 ml) ascites, the abdominal girth of patients decreased (P lt;0.05), the urine volume of 24 h tended to normal and during which no serious side-effect happened. The levels of serum BUN, CREA, prothrombin time (PT), and activated partial thromboplastin time (APTT) decreased significantly (P lt;0.05), furthermore the levels of total albumen and albumin increased significantly (P lt;0.05). The changes of serum electrolyte measurements were not significant (P gt;0.05). The follow-up period for all the patients was in the range of 4 to 37 months (mean 19 months). Then 12 patients were treated by the second operation at 3-6 months after discharge.
Conclusions The ascites retransfusion provides a safe and effective treatment option for patients with refractory ascites, and yields a higher likelihood of discharge compared with conventional paracentesis. It is useful in improving quality of life and winning the operational chance for such as patients with complicated Budd-Chiari syndrome.

Citation： LI Zhen ,WANG Zhonggao,HUO Xiaosen,WANG Leiyong,JI Feng,BIAN Ce. Effect of Venous Retransfusion of Ascites on Treatment of Complicated Patients with Budd-Chiari Syndrome. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(8): 828-831下转836. doi: Copy

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2.	Li CM, Wang ZG, Gu YQ, et al. Management of complex patients with BuddChiari syndrome [J]. Ann Vasc Surg, 2010; 24(3): 301307.
3.	Senousy BE, Draganov PV. Evaluation and management of patients with refractory ascites [J]. World J Gastroenterol, 2009; 15(1): 6780.
4.	Kuiper JJ, de Man RA, van Buuren HR. Review article: Management of ascites and associated complications in patients with cirrhosis [J]. Aliment Pharmacol Ther, 2007; 26 Suppl 2: 183193.
5.	李震, 汪忠镐, 卞策, 等. 肠房转流通畅前提下并发顽固性腹水的治疗 [J]. 中国普外基础与临床杂志, 2009; 16(7): 571572.
6.	Mller S, Henriksen JH, Bendtsen F. Ascites: pathogenesis and therapeutic principles [J]. Scand J Gastroenterol, 2009; 44(8): 902911.
7.	Hou W, Sanyal AJ. Ascites: diagnosis and management [J]. Med Clin North Am, 2009; 93(4): 801817.
8.	Kashani A, Landaverde C, Medici V, et al. Fluid retention in cirrhosis: pathophysiology and management [J]. QJM, 2008; 101(2): 7185.
9.	严律南, 李波, 曾勇, 等. 活体肝移植治疗布加综合征并下腔静脉狭窄 [J]. 中国普外基础与临床杂志, 2006; 13(1): 8284, 88.
10.	Kiafar C, Gilani N. Hepatic hydrothorax: current concepts of pathophysiology and treatment options [J]. Ann Hepatol, 2008; 7(4): 313320.
11.	Saadeh S, Davis GL. Management of ascites in patients with endstage liver disease [J]. Rev Gastroenterol Disord, 2004; 4(4): 175185.
12.	Bhattacharya A, Mittal BR, Biswsa T, et al. Radioisotope scintigraphy in the diagnosis of hepatic hydrothorax [J]. J Gastroenterol Hepatol, 2001; 16(3): 317321.
13.	汪忠镐, 李震. 我国血管外科的现状和发展 [J]. 中国普外基础与临床杂志, 2006; 13(6): 625628.
14.	Wang ZG, Zhang FJ, Li XJ, et al. Management of BuddChiari syndrome: what is the best approach? [J]. J Gastroenterol Hepatol, 2004; 19 (S7): S212S218.
15.	Wang ZG, Jone RS. BuddChiari syndrome [J]. Curr Probl Surg, 1996; 33(2): 83211.
16.	Slakey DP, Klein AS, Venbrux AC, et al. BuddChiari Syndrome: current management options [J]. Ann Surg, 2001; 233(4): 522527.
17.	Cheruvattath R, Balan V. Infections in patients with endstage liver disease [J]. J Clin Gastroenterol, 2007; 41(4): 403411.
18.	Lee JM, Han KH, Ahn SH. Ascites and spontaneous bacterial peritonitis: an Asian perspective [J]. J Gastroenterol Hepatol, 2009; 24(9): 14941503.
19.	Mller S, Henriksen JH, Bendtsen F. Pathogenetic background for treatment of ascites and hepatorenal syndrome [J]. Hepatol Int, 2008; 2(4): 416428.
20.	Tomiyama K, Takahashi M, Fujii T, et al. Improved quality of life for malignant ascites patients by Denver peritoneovenous shunts [J]. Anticancer Res, 2006; 26(3B): 23932395.
21.	Kawamoto J, Kimura F, Shimizu H, et al. Successful treatment for intractable ascites with uterine cancer using double Denver peritoneovenous shunt system [J]. Gan To Kagaku Ryoho, 2006; 33(12): 19191923.
22.	Won JY, Choi SY, Ko HK, et al. Percutaneous peritoneovenous shunt for treatment of refractory ascites [J]. J Vasc Interv Radiol, 2008; 19(12): 17171722.
23.	Seike M, Maetani I, Sakai Y. Treatment of malignant ascites in patients with advanced cancer: peritoneovenous shunt versus paracentesis [J]. J Gastroenterol Hepatol, 2007; 22(12): 21612166.
24.	Oida T, Mimatsu K, Kawasaki A, et al. Implantation of a Denver shunt by left subclavian approach for preventing kinking [J]. Hepatogastroenterology, 2009; 56(93): 10741077.
25.	Rosemurgy AS, Zervos EE, Clark WC, et al. TIPS versus peritoneovenous shunt in the treatment of medically intractable ascites: a prospective randomized trial [J]. Ann Surg, 2004; 239(6): 883889.

1. Ginès P, Cárdenas A, Arroyo V, et al. Management of cirrhosis and ascites [J]. N Engl J Med, 2004; 350(16): 16461654.
2. Li CM, Wang ZG, Gu YQ, et al. Management of complex patients with BuddChiari syndrome [J]. Ann Vasc Surg, 2010; 24(3): 301307.
3. Senousy BE, Draganov PV. Evaluation and management of patients with refractory ascites [J]. World J Gastroenterol, 2009; 15(1): 6780.
4. Kuiper JJ, de Man RA, van Buuren HR. Review article: Management of ascites and associated complications in patients with cirrhosis [J]. Aliment Pharmacol Ther, 2007; 26 Suppl 2: 183193.
5. 李震, 汪忠镐, 卞策, 等. 肠房转流通畅前提下并发顽固性腹水的治疗 [J]. 中国普外基础与临床杂志, 2009; 16(7): 571572.
6. Mller S, Henriksen JH, Bendtsen F. Ascites: pathogenesis and therapeutic principles [J]. Scand J Gastroenterol, 2009; 44(8): 902911.
7. Hou W, Sanyal AJ. Ascites: diagnosis and management [J]. Med Clin North Am, 2009; 93(4): 801817.
8. Kashani A, Landaverde C, Medici V, et al. Fluid retention in cirrhosis: pathophysiology and management [J]. QJM, 2008; 101(2): 7185.
9. 严律南, 李波, 曾勇, 等. 活体肝移植治疗布加综合征并下腔静脉狭窄 [J]. 中国普外基础与临床杂志, 2006; 13(1): 8284, 88.
10. Kiafar C, Gilani N. Hepatic hydrothorax: current concepts of pathophysiology and treatment options [J]. Ann Hepatol, 2008; 7(4): 313320.
11. Saadeh S, Davis GL. Management of ascites in patients with endstage liver disease [J]. Rev Gastroenterol Disord, 2004; 4(4): 175185.
12. Bhattacharya A, Mittal BR, Biswsa T, et al. Radioisotope scintigraphy in the diagnosis of hepatic hydrothorax [J]. J Gastroenterol Hepatol, 2001; 16(3): 317321.
13. 汪忠镐, 李震. 我国血管外科的现状和发展 [J]. 中国普外基础与临床杂志, 2006; 13(6): 625628.
14. Wang ZG, Zhang FJ, Li XJ, et al. Management of BuddChiari syndrome: what is the best approach? [J]. J Gastroenterol Hepatol, 2004; 19 (S7): S212S218.
15. Wang ZG, Jone RS. BuddChiari syndrome [J]. Curr Probl Surg, 1996; 33(2): 83211.
16. Slakey DP, Klein AS, Venbrux AC, et al. BuddChiari Syndrome: current management options [J]. Ann Surg, 2001; 233(4): 522527.
17. Cheruvattath R, Balan V. Infections in patients with endstage liver disease [J]. J Clin Gastroenterol, 2007; 41(4): 403411.
18. Lee JM, Han KH, Ahn SH. Ascites and spontaneous bacterial peritonitis: an Asian perspective [J]. J Gastroenterol Hepatol, 2009; 24(9): 14941503.
19. Mller S, Henriksen JH, Bendtsen F. Pathogenetic background for treatment of ascites and hepatorenal syndrome [J]. Hepatol Int, 2008; 2(4): 416428.
20. Tomiyama K, Takahashi M, Fujii T, et al. Improved quality of life for malignant ascites patients by Denver peritoneovenous shunts [J]. Anticancer Res, 2006; 26(3B): 23932395.
21. Kawamoto J, Kimura F, Shimizu H, et al. Successful treatment for intractable ascites with uterine cancer using double Denver peritoneovenous shunt system [J]. Gan To Kagaku Ryoho, 2006; 33(12): 19191923.
22. Won JY, Choi SY, Ko HK, et al. Percutaneous peritoneovenous shunt for treatment of refractory ascites [J]. J Vasc Interv Radiol, 2008; 19(12): 17171722.
23. Seike M, Maetani I, Sakai Y. Treatment of malignant ascites in patients with advanced cancer: peritoneovenous shunt versus paracentesis [J]. J Gastroenterol Hepatol, 2007; 22(12): 21612166.
24. Oida T, Mimatsu K, Kawasaki A, et al. Implantation of a Denver shunt by left subclavian approach for preventing kinking [J]. Hepatogastroenterology, 2009; 56(93): 10741077.
25. Rosemurgy AS, Zervos EE, Clark WC, et al. TIPS versus peritoneovenous shunt in the treatment of medically intractable ascites: a prospective randomized trial [J]. Ann Surg, 2004; 239(6): 883889.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effect of Venous Retransfusion of Ascites on Treatment of Complicated Patients with Budd-Chiari Syndrome

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