| Background and objectiveBudd-Chiari syndrome (B-CS) refers to posthepatic Portal hypertension (PHT) and/or inferior vena cava (IVC) hypertension caused by obstruction of blood flow in outlet of major hepatic veins and/or posthepatic inferior vena cava. Following the first case reported 160 years ago, more cases have been reported with the development of medicine and the increasing knowledge of this disease. From May 1983 to June 2001, Professor Xu Peiqin et al had treated more than 1,280 patients with B-CS which results from many causes and has different pathological types. Different pathologic lesion positions and ranges of hepatic vein (HV) and IVC, the forming of PHT, compensatory ability of blood flow and the forming of collateral branches in and out liver contribute to complex changes of hemodynamics in patients with B-CS. The research of B-CS concentrates on etiology and treatment in foreign countries and focuses on clinical treatment methods in our country today, but few researchers on change regularities and clinical application of hemodynamics of B-CS. In this research, combined with the follow-ups, the measurements of free portal pressure (FPP) and/or IVC pressure before and after shunt, we used the Color Doppler to measure the pre- and postoperative hemodynamics parameters of the IVC stem andthe Spleen Vein (SPY) together with the circumstances of HV, IVC, the bypasses in and out liver in 40 B-CS patients and 24 PHT patients with cirrhosis after hepatitis to investigate the change patterns of hemodynamics, applications in clinical diagnosis, selection of operative methods, measurement of prognosis in patients with B-CS and to explore differences in change patterns of hemodynamics, selection of operative methods, measurement of prognosis between B-CS and intrahepatic PHT. Patients and methods40 cases (18~56yr) in B-CS group including 25 males and 15 females, mean age was 34.5 9.70 years. 24 cases (26~68yr) in PHT group including 15 males and 9 females, mean age 45.1 11.56 years. In contrast group there were 24 healthy persons (22~56yr) including 15 males and 9 females, mean age35.88 7.78 years. We measured vessel diameter, mean flow speed, direction of blood flow and blood volume of PV and SPV in patients before operation and three months after operation and the contrast individuls by two dimensional Doppler sonography and Color Doppler sonography; at the same time, we counted the blood flow volume and observed the situations of HV, IVC and the position and quantity of collateral branches. The blood flow volume was calculated with the flowing equation: Q=Vmean (D/2) 2 60 (Q: flow volume per minute, Vmean: mean blood flow rate, D: diameter of blood vessel). The measurement point of PV was 2cm under the cross of left and right main branches. The measurement point of SPV was main stem of SPV near hilum of spleen. The most wide position and outlet of HV was measured. The measurement point of IVC was 2cm under obstruction or narrow. We measure FPP before and after shunt intraoperatively (we used a venous pressure pipe connecting with a needle to puncture gastroepiploic vein and the pressure of it represents FPP). We measured pressure of IVC before and after radical removal of membrane and IVC bypass intraoperative using the same method to puncture IVC under the obstruction.Results1 In B-CS group, 38 patients (95%) with HV pathologic changes which including the outlet obstruction or narrow, winding or dilation in distal HV.2 In the same group, 24 patients (60%) with IVC pathologic changes, 2 (5%) patients with IVC changes alone, 22 (55%) patients combined with HV changes. The main changes are membranous obstruction, narrow, occlusion, thrombosis under the obstruction, beating of IVC disappeared, speeding flow, double-direction flow or reversed flow.3 The particular bypasses appeared in B-CS patients, which among the main HVs and blood from the obstructive HV to unobstructed HV, sub-HVs dilated.4 In B-CS and PHT groups, there were one and two patients with...
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