Kasahara Mureo, Kozaki Koichi, Yoshida Toru, Yamamoto Hidekazu, Ogawa Kohei, Ogura Yasuhiro, Tanaka Koichi
Organ Transplant Unit, Kyoto University Hospital, Kyoto, Japan.
J Hepatobiliary Pancreat Surg. 2004;11(5):330-2. doi: 10.1007/s00534-004-0889-4.
Because right-lobe living-donor liver transplantation was introduced in adult-to-adult liver transplantation to mitigate the problems of small-for-size grafts, some technical controversies have been reported. This report describes a case of graft subcapsular hematoma due to parenchymal injury. A 53-year-old woman underwent a right-lobe living-donor liver transplantation for acute-on-chronic liver failure due to primary biliary cirrhosis. A huge subcapsular hematoma was discovered by routine Doppler echogram examination on the first posttransplantation day. Relaparotomy findings revealed that rotation of the graft for the hemostasis procedure during the transplant operation had induced a compression injury to the graft by the xiphoid process. It was speculated that a small laceration in the graft parenchyma led to the major subcapsular hematoma. This experience suggests that the graft liver must be handled with special care to prevent potential mechanical injury.
由于右叶活体肝移植被引入成人对成人肝移植以缓解小体积移植物的问题，一些技术争议已被报道。本报告描述了一例因实质损伤导致的移植物包膜下血肿病例。一名53岁女性因原发性胆汁性肝硬化导致的慢加急性肝衰竭接受了右叶活体肝移植。术后第一天常规多普勒超声检查发现巨大的包膜下血肿。再次剖腹探查结果显示，移植手术中为进行止血操作而旋转移植物时，剑突对移植物造成了压迫损伤。推测移植物实质内的小裂伤导致了主要的包膜下血肿。该经验表明，必须特别小心地处理移植肝脏以防止潜在的机械损伤。
