Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
Surg Today. 2011 Jul;41(7):1026-8. doi: 10.1007/s00595-010-4376-z. Epub 2011 Jul 12.
The key consideration when performing living donor liver transplantation (LDLT) in patients with Budd-Chiari syndrome (BCS) is careful management of a stenotic or occluded inferior vena cava (IVC), because it is not possible to replace the recipient stenotic or occluded IVC with donor IVC as in cadaver donor transplantation. We describe how we performed LDLT with extensive thrombectomy in a patient with acute-on-chronic BCS with a totally thrombosed retrohepatic IVC. The operation was successful and the patient remains well, with follow-up images showing a patent IVC and hepatic veins. To our knowledge, LDLT for a BCS patient with severe extensive caval thrombus has never been reported before. We consider that the successful outcome of this patient clearly demonstrates the feasibility of our technique of extensive thrombectomy, without a vessel graft, to manage a stenotic or occluded IVC in LDLT in patients with BCS.
在布加综合征（BCS）患者中进行活体肝移植（LDLT）时，关键考虑因素是仔细处理狭窄或闭塞的下腔静脉（IVC），因为不可能像在尸体供体移植中那样用供体 IVC 替代受体狭窄或闭塞的 IVC。我们描述了如何在一名慢性加急性 BCS 患者中进行 LDLT，并进行广泛血栓切除术，该患者的肝后 IVC 完全血栓形成。手术成功，患者情况良好，随访图像显示 IVC 和肝静脉通畅。据我们所知，以前从未有报道过 LDLT 治疗严重广泛腔静脉血栓形成的 BCS 患者。我们认为，该患者的成功结果清楚地表明了我们在 LDLT 中不使用血管移植物广泛血栓切除术治疗 BCS 患者狭窄或闭塞 IVC 的技术的可行性。
