Abstract: Objective:To investigate the clinical efficacy of interventional treatment for BuddChiari syndrome (BCS) in patients with hepatic vein occlusion.
Methods:The clinical data of 69 patients with BCS who received interventional treatment at the Anhui Provincial Hospital and Affiliated Hospital of Xuzhou Medical College from December 2010 to December 2012 were retrospectively analyzed. The hepatic vein was recanalized by balloon dilatation or stent implantation via jugular vein,femoral vein or percutalleous transhepatic approach or via inferior vena cava.Transjugular intraheptic portosystemic shut was applied when recanalization of hepatic vein failed. The changes of hepatic vein pressure and the clinical symptoms were observed, and the posttreatment disease free survival rate was evaluated. Patients were followed up by phone call and outpatient examination till July 2013.The measurement data were presented as ±s, and were analyzed using the t test. Ranked data were analyzed using the Wilcoxon W test. The survival curve was drawn using the KaplanMeier method, and the survival rate was compared using the Logrank test.
Results:Interventional treatment was successfully performed on 66 patients. Transjugular intervention was applied on 43 patients,transfemoral intervention on 14 patients and percutaneous transhepatic intervention on 9 patients. Fortyone patients received balloon dilatation, 14 received balloon dilatation+thrombolysis, 6 received balloon dilatation+stent implantation, and 5 received balloon dilatation+thrombolysis+stent implantation. The symptoms of 61 patients were completely relieved after treatment, and the symptoms of 5 patients were partially relieved. The hepatic vein pressures before and after treatment were (47±9)cmH2O (1 cmH2O=0.098 kPa) and (23±7)cmH2O, with significant difference between the 2 groups (t=9.73, P<0.05). The number of patients with peritoneal effusion decreased from 66 before operation to 13 after operation (Z=10.38, P<0.05). Sixtysix patients were followed up with the median time of followup of 15 months (range, 6-24 months). BCSrelated symptoms were detected during the followup in 10 patients, and 7 patients were cured by reinterventional treatment, and reparative treatment was failed in the other 3 patients. The diseasefree survival rates at month 6, 12 and 24 after initial interventional therapy were 97.0%, 92.2% and 76.4%, and the diseasefree survival rates at month 6, 12 and 24 after reparative treatment were 98.4%, 98.4% and 92.3%. The diseasefree survival rates of patients who received balloon dilation, balloon dilation+thrombolysis, balloon dilation+stent implantation, balloon dilation+thrombolysis+stent implantation were 90.2%, 71.4%, 83.3%and 80.0%, respectively. There was no significant difference in the diseasefree survival rates among different treatment methods (χ ²=3.08, P>0.05).
Conclusion:Interventional treatment of BCS has the advantages of high success rate, low recurrence rate and high middleshort term diseasefree survival rate.