Varotti Giovanni, Andorno Enzo, Casaccia Marco, Di Domenico Stefano, Bottino Giuliano, Diviacco Pietro, Morelli Nicola, Ferrari Chiara, Ferrante Roberto, Valente Umberto
Department of Surgery and Transplantation, San Martino Hospital, University of Genoa, Monoblocco IV, Largo R. Benzi 10, 16132 Genoa, Italy.
J Transplant. 2010;2010. doi: 10.1155/2010/570392. Epub 2010 Aug 9.
Two-stage liver transplantation (LT) has been reported for cases of fulminant liver failure that can lead to toxic hepatic syndrome, or massive hemorrhages resulting in uncontrollable bleeding. Technically, the first stage of the procedure consists of a total hepatectomy with preservation of the recipient's inferior vena cava (IVC), followed by the creation of a temporary end-to-side porto-caval shunt (TPCS). The second stage consists of removing the TPCS and implanting a liver graft when one becomes available. We report a case of a two-stage total hepatectomy and LT in which a temporary end-to-end anastomosis between the portal vein and the middle hepatic vein (TPMHV) was performed as an alternative to the classic end-to-end TPCS. The creation of a TPMHV proved technically feasible and showed some advantages compared to the standard TPCS. In cases in which a two-stage LT with side-to-side caval reconstruction is utilized, TPMHV can be considered as a safe and effective alternative to standard TPCS.
对于可能导致中毒性肝综合征的暴发性肝衰竭病例或导致无法控制出血的大量出血情况，已有两阶段肝移植（LT）的报道。从技术上讲，该手术的第一阶段包括全肝切除术并保留受者的下腔静脉（IVC），随后建立临时端侧门腔分流术（TPCS）。第二阶段包括移除TPCS并在有肝脏移植物时进行植入。我们报告了一例两阶段全肝切除术和LT病例，其中门静脉与肝中静脉之间进行了临时端端吻合（TPMHV），作为经典端端TPCS的替代方法。事实证明，TPMHV的建立在技术上是可行的，并且与标准TPCS相比具有一些优势。在采用侧侧腔静脉重建的两阶段LT病例中，TPMHV可被视为标准TPCS的一种安全有效的替代方法。
