title: Surgical treatment of Budd-Chiari syndrome: analysis of 221 cases.
abstract: BACKGROUND
  Budd-Chiari syndrome (B-CS) refers to post-hepatic portal hypertension and/or inferior vena cava hypertension caused by obstruction of blood flow at the portal cardinal hepatic vein. The treatments of B-CS include operations on pathological membrane lesions, shunting and combined operations. Studies have shown that China, Japan, India and South Africa have a high incidence of B-CS. In China, the Yellow River Basin in Henan, Shandong, Jiangsu and Anhui Provinces also have a high incidence, around 10 per 100 000.
  
  
  METHODS
  The clinical data of 221 B-CS patients were analyzed retrospectively. We focused on pathological types, surgical methods, effectiveness and complications of treatment, and follow-up.
  
  
  RESULTS
  Based on imaging findings such as color ultrasonography, angiography or magnetic resonance angiography, the 221 patients were divided into 3 types (five subtypes): type Ia (72 patients), type Ib (20), type II (72), type IIIa (33), and type IIIb (24). Surgical procedures included balloon membranotomy with or without stent (65 patients), improved splenopneumopexy (18), radical resection of membrane and thrombus (17), inferior vena cava bypass [29, with cavocaval transflow (13) and cavoatrial transflow (16)], mesocaval shunt (41), splenocaval shunt (25), splenoatrial shunt (12), splenojugular shunt (6), and combined methods (8). The complication rate was 9.05% (20/221) and the perioperative death rate was 2.26% (5/221). All of the patients were followed up from 6 months to 5 years. The success rate was 84.6% (187/221), and the recurrence rate was 8.9% (9/101) and 13.5% (13/96) after 1- and 5-year follow-up, respectively.
  
  
  CONCLUSIONS
  The rational choice of surgical treatment based on B-CS pathological typing may increase the success rate and decrease the recurrence.
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China. dangxw1001@163.com
authors.forename: Xiao-Wei
authors.initials: XW
authors.lastname: Dang
authors.forename: Pei-Qin
authors.initials: PQ
authors.lastname: Xu
authors.forename: Xiu-Xian
authors.initials: XX
authors.lastname: Ma
authors.forename: Da-Qian
authors.initials: DQ
authors.lastname: Xu
authors.forename: Yan-Ju
authors.initials: YJ
authors.lastname: Zhu
authors.forename: Yong-Shuai
authors.initials: YS
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006502:Budd-Chiari Syndrome / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D002681:China; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult