Preoperative Diagnosis of Hepatic Sinus Obstruction Syndrome Caused by Tusanqi and Evaluation of Therapeutic Effects after TIPS by Imaging and Pathology

Abstract BACKGROUND:Transjugular intrahepatic portosystemic shunt(TIPS) is a method for the treatment of hepatic sinus obstruction syndrome (HSOS). This study investigated the preoperative diagnosis and prognosis of hsos caused by Tushanqi from the perspective of imaging and pathology. MATERIAL AND METHOD: TIPS was administered to our hospital for 19 patients with HSOS who had a history of taking Tusanqi soaking liquor or Chinese medicine between September 2014 to December 2018. They underwent enhanced abdominal CT or MR scans on the day before surgery and one month after surgery. ultrasound-guided liver biopsy, and specimens for HE staining.RESULTS:Preoperative imaging showed increased liver volume, uneven density, moderate to severe effusion in the abdominal cavity, thickening and distortion of the hepatic artery, uneven perfusion of the liver parenchyma, slender or unclear three hepatic veins, and slender inferior vena cava or flat, but still unobstructed. Pathological examination showed extensive edema and degeneration of hepatocytes. hepatic sinus was obviously congested, dilated, fibrous connective tissue proliferated, and expanded venules in the interfiber space.One month after operation: the liver volume was smaller than before, no obvious abnormalities were found in the liver parenchyma, and the peritoneal effusion was significantly less or even disappeared.Postoperative pathology showed marked improvement of hepatocellular edema, slight dilatation and congestion of hepatic sinus.CONCLUSIONS: Imaging and pathology can help the diagnosis of HSOS by Tusanqi , but also evaluate the therapeutic effect of TIPS on the disease.