Hepatic venousaplasty and transjugular intrahepatic portosystemic shunt in the treatment of Budd-Chiari syndrome with occlusion of the hepatic veins / 中华外科杂志

<p><b>OBJECTIVE</b>To determine the outcome of hepatic venousaplasty and transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of the Budd-Chiari syndrome with occlusion of the hepatic veins.</p><p><b>METHODS</b>Fifty patients of the Budd-Chiari syndrome with occlusion of the hepatic veins (23 males and 27 females, with a mean age of (39 ± 11) years) were elected for venousaplasty or TIPS. The average of Child-Pugh scores was 9.6 ± 2.6. Three patients had a acute course of the disease, while 47 patients had a subacute or a chronic course of the disease. The clinical presentation was ascites in all 50 cases, with concomitant upper gastrointestinal bleeding in 10 patients, hepatorenal syndrome in 4 patients and impaired liver function in all patients. Hepatic venousplasty was performed for 12 patients with occlusion of hepatic venous. Hepatic and inferior caval venousplasty were performed for 6 patients with occlusion of hepatic and inferior caval vein. TIPS was performed for 13 patients with occlusion of small hepatic vein. Modified TIPS was performed for 19 patients with extensive occlusion of hepatic vein.</p><p><b>RESULTS</b>The procedure of treatment was successfully performed in all patients. The shunt reduced the portosystemic pressure gradient from (41 ± 10) to (27 ± 6) cmH2O (1 cmH2O = 0.098 kPa, t = 20.20, P = 0.001) and improved the portal flow velocity from (14 ± 10) to (52 ± 14) cm/s (t = 15.02, P = 0.001) after TIPS or modified TIPS. Clinical symptoms and the biochemical test results improved significantly during 3 weeks after hepatic venousplasty and shunt treatment. During the hospitalization, the death occurred in 1 case due to hepatic failure and the acute occlusion of shunt was treated with secondary intervention in another case. The mean follow-up was (82 ± 46) months. The revisions of shunt with TIPS were needed in 2 patients and the inflation of stenosised hepatic vein in another 2 patients during the follow-up. All patients were still observed.</p><p><b>CONCLUSION</b>Hepatic venousaplasty and TIPS provide an excellent outcome in patients of Budd-Chiari syndrome with occlusion of the hepatic veins.</p>

The retrospective study of transjugular intrahepatic portosystemic shunt with covered or uncovered stents in patients with portal hypertension / 中华外科杂志

<p><b>OBJECTIVE</b>To retrospectively compare the clinical outcome in patients with portal hypertension treated with transjugular intrahepatic portosystemic shunt (TIPS) using Fluency stent-graft (PTFE-covered stents) or bare stents.</p><p><b>METHODS</b>Approval of study and treatment protocol and waiver of informed consent for the retrospective study were obtained from institutional review board. Informed consent was obtained from each patient before procedure. Sixty consecutive patients with portal hypertension treated with TIPS from April 2007 to April 2009 were included. TIPS creation was performed with Fluency stent-graft in 30 patients (group A) and with bare stents in 30 patients (group B). Liver function, TIPS patency and clinical outcome were evaluated every 3 months.</p><p><b>RESULTS</b>During hospitalization, there was no hepatic encephalopathy and recurrency of variceal bleeding.Acute shunt occlusion was observed in one patient with group A and another patient with group B.Follow-up was performed with average time of (6.2 +/- 3.9) months in group A and (8.3 +/- 4.4) months in group B. The rates of recurrent bleeding, acute shunt occlusion, hepatic encephalopathy and death were 3.3% and 20.0%, 0 and 30.0%, 16.7% and 20.0%, 0 and 13.3% in group A and B. The rates of recurrent bleeding, acute shunt occlusion and death in group A was lower than those in group B. There was no difference of hepatic encephalopathy between group A and B. The decrease of portal pressure and portosystemic pressure gradient, and the increase of portal flow and shunt flow in group A were higher than those in group B. There were no difference of liver function, ammonia and MELD between group A and B.</p><p><b>CONCLUSIONS</b>Fluency stent-graft is safe and effective in TIPS creation, with high patency rate. Covered-stent can improve the clinical outcome of portal hypertension.</p>

Analysis of surveillance results of iodine deficiency disorders in Xunhua county Qinghai province in 2008 / 中国地方病学杂志

Objective To understand the iodine deficiency disorders in Xunhua county Qinghai province, and to provide reference values for setting up prevention and control strategy. Methods According to historical data of Xunhua county, 1 township center elementary school and 1 village elementary school were sampled in Qingshui, Baizhuang, Hongqi, Jiezi and Galeng townships. A total of 9 elementary schools were investigated (Caleng has only 1 elementary school). Fourty children aged 8-10 years were checked thyroid size by palpation in every school. Twenty children were chosen to assay their urinary iodine and edible salt iodine in every school. Thirty 5-grade students were surveyed by questionnaire on health education in every school. Ten housewives were inquired prevention knowledge on iodine deficiency disorders and salt iodine level was tested in every village. Results Goiter rate was 7.9%(30/378) in children aged 8-10 years, with Baizhuang and Galeng the highest (11.9%,5/42), and Qingshui the lowest (2.4%, 1/42). The median was 196.5 μg/L in children aged 8-10 years, and urinary iodine level lower than 50 μg/L was accounted for 5.3% (11/208), but that value was 25.0% (5/20)in Galeng. The average qualified rate of using edible salt was 91.4%(159/174), and that rates were 79.0%(15/19), 83.3%(15/18) and 89.5%(17/19) in Chajia, Tuanjie and Minzhu villages, respectively. The average score were 2.8, 2.1 in health education survey of the 5-grade students and housewives. Conclusions After years effort in prevention and control of iodine deficiency disorders, remarkable progress has been made in Xunhua County. The monitoring of iodized salt and the knowledge spreading are still need to be strengthened.

Long-term results of TIPS, TIPS with CVO and combined TIPS and portal azygous disconnection for the treatment of portal hypertension / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the long-term results of TIPS, TIPS with coronary vein occlusion (CVO) and combined TIPS and portal azygous disconnection for the treatment of portal hypertension and variceal bleedings.</p><p><b>METHODS</b>Three hundreds and fifty-eight patients with portal hypertension were admitted because of variceal bleeding from July 1993 to May 2008. All patients were divided into 3 groups: 227 cases in group TIPS, 36 cases in TIPS and CVO group, 95 cases in combined TIPS and portal azygous disconnection group. The rates of successful operation, shunt patency, rebleeding, encephalopathy and survival were observed and compared by statistics methods.</p><p><b>RESULTS</b>There were 349 cases (97.5%) underwent successful surgery and 9 cases with failure surgery. The rates of occluded shunts, encephalopathy, rebleeding, and death in early periods were 2.5%, 31.8%, 4.7% and 9.0% respectively. The rate of encephalopathy and death in group with TIPS were higher than in group with combined TIPS and portal azygous disconnection (P < 0.01). The rate of encephalopathy and death were 41.2% and 24.7% in 85 cases with emergency TIPS. During the follow-up 1 - 15 years, the rate of patency shunts in 12 and 24 months after operation was 74.0% and 48.1% respectively. The rate of 1-year patency shunts in group with combined TIPS and portal azygous disconnection was higher than in group with TIPS, TIPS and CVO (P < 0.01 and P < 0.05). The rebleeding in group with TIPS was higher than in group with combined TIPS and portal azygous disconnection (P < 0.01), and the survival rate in group with TIPS was lower than in group with TIPS and CVO, combined TIPS and portal azygous disconnection (P < 0.01 and P < 0.01).</p><p><b>CONCLUSIONS</b>TIPS is an efficient therapy for portal hypertension with CVO, combined TIPS and portal azygous disconnection can improve the results of TIPS for portal hypertension.</p>

Transjugular intrahepatic portosystemic shunt in the treatment of Budd-Chiari syndrome with extensive occlusion of the hepatic veins / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the outcome of a transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of 11 patients with Budd-Chiari syndrome with extensive occlusion of the hepatic veins.</p><p><b>METHODS</b>Eleven patients with Budd-Chiari syndrome with extensive occlusion of the hepatic veins were elected for TIPS. Three patients had a acute; eight, a subacute or a chronic course of the disease. All patients were associated with variceal bleeding and massive ascites. The diagnosis of Budd-Chiari syndrome was established by duplex-sonography, CT, MRI, upper digestive barium meal, angiography of hepatic veins and IVC, and liver biopsy. The shunt with diameter of 10 cm was established between the inferior caval vein and the intrahepatic portal vein with self-expandable stents in all patients. The mean follow-up was 63 +/- 43 months.</p><p><b>RESULTS</b>The shunt reduced the portasystemic pressure gradient from 41.2 +/- 10.5 to 12.4 +/- 4.7 cm H2O and improved the portal flow velocity from 11.2 +/- 2.8 to 52.2 +/- 13.7 cm/s. Clinical symptoms and the biochemical test results improved significantly during 3 weeks after shunt treatment. Ten patients are alive without clinical symptoms except one death due to hepatic failure. Revision in 2 patients was needed during the follow-up. The inflation of stenosing shunt was performed in 1 patient, and the reimplantation of stent in another patient. Eight patients had no revisions.</p><p><b>CONCLUSIONS</b>TIPS provided an excellent outcome in patients with Budd-Chiari syndrome with extensive occlusion of the hepatic veins. It might be regarded as a treatment for the acute and long-term management of these patients.</p>