Transhepatic Coil Embolization for Ectopic Varices After Pediatric Liver-intestine Transplantation
Transhepatic Coil Embolization for Ectopic Varices After Pediatric Liver-intestine Transplantation
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经肝弹簧圈栓塞治疗小儿肝肠移植后异位静脉曲张
DOI：
10.1097/tp.0000000000003985
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发表时间：
2022
期刊：
影响因子：
6.2
通讯作者：
Kasahara Mureo
中科院分区：
文献类型：
--
作者：
Sakamoto Seisuke;Uchida Hajime;Shimizu Seiichi;Yanagi Yusuke;Mimori Kotaro;Nakao Toshimasa;Fukuda Akinari;Arai Katsuhiro;Nosaka Shunsuke;Kasahara Mureo
我们最近报告了一例肠衰竭的儿科病例，接受了连续的已故供体肠移植（Tx），然后进行活体供体肝脏移植。1他的移植肠目前功能良好。然而，肝功能检查显示轻度升高，连续肝活检显示纤维化进展。这种肝功能障碍的一个可能原因是肠移植物的全身引流，这可能对门静脉血流产生不利影响，因为肝移植物可能容易受到血流不足的影响。2该患者体重13.2 kg，4岁时在肠道Tx后2.5年出现胃肠道（GI）出血伴严重贫血。内镜检查显示异位静脉曲张位于移植肠的上吻合口（图1A）。增强腹部计算机断层扫描（CT）否认门静脉狭窄或血栓形成;然而，可见移植肠肠系膜扩张血管引流至下腔静脉。经皮门静脉造影显示通过移植肠上部吻合部位的门体通路，并成功对这些扩张血管进行了选择性弹簧圈栓塞（图1C-E）。6个月随访时的另一次内镜检查显示静脉曲张完全消失（图1B）。从那以后，他没有发生任何胃肠道出血事件。
We recently reported a pediatric case of intestinal failure undergoing sequential deceased donor intestine transplantation (Tx) followed by living donor liver Tx. 1 His transplanted intestine is currently functioning well. However, liver function tests have shown mildly increased values and serial liver biopsies have revealed the progression of fibrosis. One possible cause of such liver dysfunction is systemic drainage of the intestinal graft, which can have an adverse effect on portal venous flow, as a hepatic graft can be vulnerable to insufficient flow. 2 This patient weighing 13.2 kg presented with gastrointestinal (GI) bleeding with severe anemia 2.5 y after intestine Tx at 4 y of age. An endoscopic examination revealed ectopic varices located at the upper anastomotic site of the transplanted intestine (Figure 1A). Enhanced abdominal computed tomography (CT) denied portal venous stenosis or thrombosis; however, dilated vessels in the mesentery of the transplanted intestine draining into the inferior vena cava were visualized. Transhepatic portography revealed portosystemic pathways through the upper anastomotic site of the transplanted intestine and selective coil embolization on those dilated vessels was successfully performed (Figure 1C–E). Another endoscopic examination at the 6-mo follow-up showed the complete disappearance of the varices (Figure 1B). Since then, he has not experienced any episodes of GI bleeding.