Clinical Analysis Of 47 Cases Of Budd-Chiari Syndrome

Objective: To explore the clinical features of Budd-Chiari syndrome(BCS)and characteristics of different types of this disease by analyzing 47 cases of Budd-Chiari syndrome in a retrospective study.To improve awareness of BCS and provide experience for clinical diagnosis and treatment.Methods: Form September 1997 to December 2015,47 patients who was diagnosed with BCS at the first affiliated hospital of Dalian Medical University were included in this retrospective study.Date on general condition,symptoms,physical signs,laboratory examination,imaging examination,therapy and follow-up were collected and analyzed.Use descriptive statistical methods to analyze its characteristics of different types of BCS according to Xu’s classification method.Results: 47 patients were included.Study patients comprised 26 males and 21 females with a male to female ratio of 1.24.The average age of those patients was 52 years and the peak age of onset was at 50 to 60 years.According to the classification method of Xu,3 patients(6.38%)belonged to type I,19 patients(40.43%)to type II,4 patients(8.51%)to type III and 21 patients(40.43%)to type IV.The median interval time from the onset of clinical symptoms to be diagnosed was 1 year(range 1 day to 30 years).Regarding to underlying disease or possible etiology,8 patients(17.02%)had a history of chronic viral hepatitis,5 patients(10.64%)had venous thromboembolism of lower extremity,4 patients(8.51%)had tumor including one breast cancer patient and 3 liver cancer patients.One of the 3 liver cancer patient had a history of chronic viral hepatitis B.The most common clinical manifestation was abdominal distension(29/47,61.7%),edema of lower limbs(24/27,51.06%).The most common physical signs was edema of lower limbs(29/47,61.7%),subcutaneous varices vein of latero-abdominal wall(22/47,46.81%)and ascites(17/47,66.67%).The blood routine test showed 6 patients(12.77%)had hypersplenism(decrease of all three shoxzox of blood system),28 patients(59.57%)had thrombocytopenia.Liver function test showed 10 patients(21.28%)had a higher level of ALT than normal,31 patients(65.96%)had a higher level of γ-GT,7 patients(14.89%)had a higher level of ALP.37 patients’(65.96%)total bilirubin was higher and 17 among those patients had clinical jaundice.3 patients’(6.38%)prothrombin(PT)prolonged by more than 4 seconds.Compared with DSA examination,the diagnostic positive rate of Color Doppler Ultrasound,CT scan,CT enhanced scan,CTV and MRV respectively was 85.71%,33.33%,70%,100%,100%.1 patient died before the starting of treatment,12 patients received conservative treatment,4 patients received TIPS,and other 30 patients received interventional therapy.Type I patients had no significant bias on the choice of specific surgical procedure.12 patients(63.16%)of type II patients received angioplasty,11 patients(52.38%)of type IV patients received angioplasty pulse stent implantation.Thrombus aspiration and catheter direct thrombolysis were only choosed by type III patients.8 patients had a record of second admission due to relapse after interventional treatment;the average reoccurrence interval was 19 months(range 1 month to 3 year).Conclusion:1、The clinical presentation of BCS was varied.Abdominal distension,edema of lower limbs,subcutaneous varices vein of latero-abdominal wall,varicose vein and pigmentation of lower extremity were the common clinical manifestation and physical signs.2、Imaging examination played an important role at the diagnosis and treatment of BCS.Ultrasound examination could be the first one for screening BCS.CTV and MRV were fit for patients who couldn’t do or refused to do the DSA examination which was the gold standard for the diagnosis of BCS.At the same time,DSA was also the important technical support for interventional therapy.3、The treatment for BCS was partly depending on the different types of BCS.Interventional therapy was the most common treatment in our country.Patients with type II usually received angioplasty.Angioplasty pulse stent implantation was mostly used by patients of type IV.Thrombus aspiration and catheter direct thrombolysis were mainly used for patients of type III.4、We should screening BCS in an early time and took an early treatment on those patients for a reducing complications of portal hypertension at one side,and protecting liver function at another side.