Pomposelli J J, DaCosta M A, McPartland K, Jenkins R L
Division of Hepatobiliary Surgery and Liver Transplantation, Lahey Clinic Medical Center, Burlington, MA, USA.
Am J Transplant. 2007 Jul;7(7):1869-71. doi: 10.1111/j.1600-6143.2007.01843.x. Epub 2007 May 19.
Situs inversus totalis is a rare anatomical abnormality that results in dextrocardia, mirror image of normal abdominal organs and other congenital abnormalities. Deceased donors with this condition are often declined on anatomic concerns. While there have been numerous reports of successful liver transplantation in recipients with situs inversus, review of the world's literature provided only three case reports using deceased donors with situs inversus. In this report, a novel approach to implantation of a liver graft from a donor with situs inversus is presented. To avoid possible torsion and blockage of venous outflow, a modified retroversus piggyback technique with 180 degrees ventral caudal (backwards) rotation of the liver graft along the axis of the vena cava was performed. This orientation resulted in the retro hepatic vena cava facing anteriorly and the larger anatomic liver lobe in the right upper quadrant. Excellent outcome was achieved without technical difficulty. Retroversus implantation of a liver graft from a donor with situs inversus is safe and effective and associated with favorable outcome.
全内脏反位是一种罕见的解剖学异常，可导致右位心、正常腹部器官的镜像以及其他先天性异常。患有这种情况的已故供体常常因解剖学方面的担忧而被拒绝。虽然有许多关于全内脏反位受者成功进行肝移植的报道，但对世界文献的回顾仅提供了三例使用全内脏反位已故供体的病例报告。在本报告中，提出了一种从全内脏反位供体植入肝移植物的新方法。为避免可能的静脉流出道扭转和阻塞，采用了改良的背驮式技术，将肝移植物沿腔静脉轴腹侧尾端（向后）旋转180度。这种方位使得肝后腔静脉朝前，右上象限有较大的解剖学肝叶。在没有技术困难的情况下取得了优异的结果。从全内脏反位供体进行肝移植物的背驮式植入是安全有效的，且预后良好。
