Liver transplantation in a patient with complete portal vein thrombosis, is there a surgical way out? A case report.
Liver transplantation in a patient with complete portal vein thrombosis, is there a surgical way out? A case report.
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DOI：
10.1016/j.amsu.2016.08.002
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发表时间：
2016-11
影响因子：
1.7
通讯作者：
Tisone, Giuseppe
中科院分区：
文献类型：
--
作者：
Manzia, Tommaso Maria;Fazzolari, Laura;Manuelli, Matteo;Pellicciaro, Marco;Baiocchi, Leonardo;Tisone, Giuseppe
由于手术过程的复杂性，门静脉血栓形成(PVT)一直被认为是肝移植(LT)的绝对禁忌症。存在大的脾肾分流(SRS)可使门静脉吻合成为一个有效的选择。我们报告一位37岁的女性患者，患有三级PVT和较大的SRS，她接受了原位肝移植。肝移植采用1992-Belghiti背负式技术，门脉吻合采用大脾肾分流术。移植血管再通良好，术后多普勒超声显示门静脉血流正常。术后第7天出院，移植物功能良好。术后6个月随访，患者肝脏血运正常。由于缺乏报道，目前对于肝移植的适应证和/或外科技术尚无共识。在目前的病例中，一旦评估了移植的益处，III级PVT不被认为是LT的禁忌症。伴大SRS的III级门静脉血栓的存在不应被认为是LT的禁忌症，使用分流静脉应被认为是执行门静脉吻合的可行选择。Yerdel III-IV门静脉转流不应被认为是肝移植的绝对控制指征。在术前影像上识别具有良好代表性的脾肾分流是肝移植计划的关键。由于高风险手术必须评估移植的益处，以估计存活的收益，手术必须由经验丰富的肝移植外科医生领导。
Due to the complexity of the surgical procedure portal vein thrombosis (PVT) has long been considered an absolute contraindication to liver transplantation (LT). The presence of a large splenorenal shunt (SRS) could make portal anastomosis a valid option. We report the case of a 37-year-old female patient with Grade III PVT and a large SRS, who underwent orthotopic LT. Liver was implanted using a 1992-Belghiti piggyback technique and portal anastomosis was performed using the large spleno-renal shunt. We observed good graft reperfusion and postoperative Doppler ultrasound showed normal portal vein flow. She was discharged on postoperative day 7, with an excellent graft function. At six months follow-up, patient is alive with normal hepatic vascularization. Due to paucity of reports, there is currently no consensus on the indication to LT and/or surgical technique. In the present case, once the transplant benefit was evaluated, the Grade III PVT was not considered a contraindication to LT. The presence of a Grade III PVT associated with a large SRS should not be considered a contraindication for LT, and the use of the shunt vein should be considered a feasible option to perform portal anastomosis. The Yerdel III–IV portal vein trombosis should not be considered an absolute controindication to liver transplantation The identification of a well represented spleno-renal shunt on the pre-operative imaging is essential to plan a liver transplantation Since the high risk surgery a transplant benefit must be evaluated in order to estimate the gain in terms of survival The operation must be lead by a high experienced liver transplant surgeon