Gerunda Giorgio E, Merenda Roberto, Neri Daniele, Angeli Paolo, Barbazza Franco, Valmasoni Michele, Feltracco Paolo, Zangrandi Fabio, Gangemi Antonio, Miotto Diego, Gagliesi Alessandro, Faccioli Alvise Maffei
Department of Medical and Surgical Sciences, III Surgical Clinic, Padua University, Padua, Italy.
Liver Transpl. 2002 Jan;8(1):72-5. doi: 10.1053/jlts.2002.30404.
Orthotopic liver transplantation (OLT) may be feasible even in the presence of diffuse portal vein thrombosis (PVT) in the recipient, providing hepatopetal portal flow to the graft can be ensured. Cavoportal hemitransposition was used in selected cases in which no other salvage solutions were technically possible. We report our experience of two patients with diffuse thrombosis of the entire portal system. One patient also had thrombosis of a previous portacaval shunt with a synthetic interposition graft. Portal pedicle dissection and native hepatectomy (with or without vena cava removal) appeared difficult. Bleeding from the exposed area was severe, and in one case, a new laparotomy was necessary to stop the abdominal hemorrhage. The postoperative course was complicated by severe ascites (with fluid infection and surgically drained suprahepatic abscess in one case), renal insufficiency (requiring dialysis in one case), esophagogastric variceal bleeding (needing several sessions of endoscopic treatment), and bronchopneumonic infections (in one case, superinfection with Aspergillus fumigatus despite amphotericin B lipid complex therapy led to the patient's death from multiorgan failure). Our experience was compared with 17 other cases in the literature. Etiologic factors, preoperative diagnostics, surgical problems, and postoperative complications are focused on and discussed. Diffuse PVT no longer appears to be an absolute contraindication to OLT, although cavoportal hemitransposition needs further experience and long-term follow-up.
原位肝移植（OLT）即使在受体存在弥漫性门静脉血栓形成（PVT）的情况下也可能可行，前提是能够确保向移植物提供向肝门静脉血流。在某些技术上无法采用其他挽救措施的情况下，采用了腔门静脉半转位术。我们报告了两例整个门静脉系统弥漫性血栓形成患者的经验。其中一例患者先前的门腔分流术使用人工血管搭桥，也出现了血栓形成。门静脉蒂解剖和原位肝切除术（伴或不伴腔静脉切除）似乎很困难。手术暴露区域出血严重，其中一例患者需要再次剖腹手术以控制腹腔出血。术后病程复杂，出现严重腹水（一例伴有液体感染和手术引流的肝上脓肿）、肾功能不全（一例需要透析）、食管胃静脉曲张出血（需要多次内镜治疗）以及支气管肺炎感染（一例，尽管使用两性霉素B脂质体复合物治疗，但烟曲霉二重感染导致患者死于多器官功能衰竭）。我们将自己的经验与文献中其他17例病例进行了比较。重点关注并讨论了病因、术前诊断、手术问题和术后并发症。弥漫性PVT似乎不再是OLT的绝对禁忌证，尽管腔门静脉半转位术还需要更多经验和长期随访。
