Meguro Makoto, Soejima Yuji, Taketomi Akinobu, Ikegami Toru, Yamashita Yo-Ichi, Harada Noboru, Itoh Shinji, Hirata Koichi, Maehara Yoshihiko
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Surg Today. 2008;38(5):463-8. doi: 10.1007/s00595-007-3623-4. Epub 2008 Apr 30.
We herein present a case of unresectable giant hepatic hemangiomas with Kasabach-Merritt syndrome which was successfully treated by living donor liver transplantation using a left lobe graft. The patient was a 45-year-old woman who complained of abdominal distension. Two sessions of transarterial embolization were performed, but failed to reduce the size of the tumor. The hepatic tumors were thus judged untreatable and the only option for a cure was to offer living donor liver transplantation, because of the tumor size, its location, and the association with Kasabach-Merritt syndrome. A left lobe graft with the middle hepatic vein donated by her 47-year-old brother was transplanted under venovenous bypass. The postoperative course of the recipient was complicated by small-for-size graft syndrome, which developed after episodes of acute cellular rejection on postoperative day 8 and sepsis on day 31. The patient successfully recovered from the complications and was discharged on day 72, and she remains well at 10 months after transplantation. In conclusion, living donor liver transplantation was found to be an effective option for the treatment of a patient with unresectable giant hepatic hemangiomas complicated by Kasabach-Merritt syndrome.
我们在此报告一例患有卡萨巴赫-梅里特综合征的不可切除巨大肝血管瘤患者，通过使用左叶移植物的活体肝移植成功治愈。患者为一名45岁女性，主诉腹胀。进行了两次经动脉栓塞治疗，但未能减小肿瘤大小。由于肿瘤大小、位置以及与卡萨巴赫-梅里特综合征的关联，肝肿瘤被判定无法治疗，唯一的治愈选择是进行活体肝移植。由她47岁的哥哥捐献的带有肝中静脉的左叶移植物在静脉-静脉转流下进行了移植。受者术后过程出现小肝移植综合征并发症，该并发症在术后第8天发生急性细胞排斥反应和第31天发生败血症后出现。患者成功从并发症中康复，于第72天出院，移植后10个月仍状况良好。总之，活体肝移植被发现是治疗患有卡萨巴赫-梅里特综合征的不可切除巨大肝血管瘤患者的有效选择。
