Buka syndrome is a group of clinical manifestations of portal hypertension and inferior vena cava hypertension due to obstruction of hepatic blood flow out of the liver by obstruction of the hepatic vein and the segmental inferior vena cava near its entrance. Common causes are congenital inferior vena cava diaphragm formation, inferior vena cava thrombosis, primary hepatic vein occlusion, true erythrocytosis, oral contraceptives, nocturnal paroxysmal hemoglobinuria and trauma. The disease is divided into acute and chronic types. Eventually, death can occur due to hepatic failure and gastrointestinal bleeding in silty cirrhosis, and the prognosis is poor. Diagnosis 1, acute type Rare. Rarely seen. It starts rapidly, develops rapidly, and dies of liver failure or gastrointestinal hemorrhage in a short period of time. 2. Chronic type More common. (1) young adults are mainly: the peak age of onset is 25-35 years old. (2) Slow onset: the course of the disease is generally 4 to 5 years. (3) Typical cases often appear simultaneously with clinical manifestations of posthepatic portal hypertension and inferior vena cava obstruction, i.e., simultaneous hepatomegaly, splenomegaly, esophageal varices, chest and abdominal wall varices, bilateral lower extremity depressed edema, and calf skin hyperpigmentation. In severe cases, the skin becomes mossy or forms ulcers. In some patients, symptoms of portal hypertension or signs of inferior vena cava obstruction predominate. In a few patients, progressive and persistent ascites is the main manifestation. (4) B-type ultrasonography: it can detect whether there is obstruction of the inferior vena cava and hepatic vein in the liver segment, the traffic condition of hepatic vein and side branch, and know whether there is neoplasm in the liver. (5) Vena cava venography: the superficial vein of upper and lower limbs can be cannulated for the contrast of inferior vena cava, which can determine whether there is obstruction of the inferior vena cava, the obstruction site, scope and degree, and at the same time, it can be used for the vena cava manometry and hepatic venography. The combination of vena cava angiography and two-dimensional ultrasonography can determine the nature, location, extent, and degree of obstruction of the inferior vena cava, as well as the presence and degree of hepatic venous communication with the inferior vena cava. Vena cava venography can not only further clarify the diagnosis but also provide a basis for choosing the surgical treatment plan. (6) Diagnosis often needs to be differentiated from portal hypertension caused by cirrhosis, ascites of cirrhosis, constrictive pericarditis, inferior vena cava obstruction syndrome, deep vein thrombosis of the lower limbs and its sequelae, tuberculous peritonitis and so on. Therapeutic measures 1. Acute type: early treatment with anticoagulants and diuretics. Portal vein decompression surgery is often intolerable to patients and has a high mortality rate, so it should be considered carefully. Chronic type: Surgery should be chosen. Surgery should be selected according to the degree and scope of obstruction of inferior vena cava and hepatic vein and the degree of compensation of collateral circulation. (1) Simple hepatic vein obstruction with patent inferior vena cava can be treated with portal-body shunt and splenopulmonary fixation. (2) Membranous obstruction of the inferior vena cava, with patent hepatic vein opening on the distal side of the obstruction can be treated with transcardiac finger or instrument rupture of membranes, transcaval vein direct septal resection, and inferior vena cava-right atrium artificial vascular diversion. The rupture of membranes is simple, but the recurrence rate is high. Inferior vena cava diaphragmectomy is more complicated and the results are not certain. Inferior vena cava-right atrium diversion has good near-term results, and the long-term results are closely related to the artificial vascular materials used. (3) Balloon catheterization or transcardiac inferior vena cava dilatation can be used if the inferior vena cava is narrow and the hepatic vein is patent. If the hepatic vein is obstructed, superior mesenteric vein-right atrium artificial blood vessel diversion or splenopulmonary fixation can be used. Splenopulmonary fixation is not suitable for those with large amount of ascites, and mesenteric atrial diversion is more effective. (4) If there is segmental occlusion of the inferior vena cava and the hepatic vein is patent, inferior vena cava-right atrium diversion is more effective. If there is concomitant hepatic vein occlusion, inferior vena cava-superior mesenteric vein-right atrium artificial vascular diversion should be used.