Uchida Hajime, Sakamoto Seisuke, Hamano Ikumi, Kobayashi Megumi, Kitajima Toshihiro, Shigeta Takanobu, Kanazawa Hiroyuki, Fukuda Akinari, Kasahara Mureo
Department of Transplantation, National Center for Child Health and Development, Tokyo, Japan.
Ann Transplant. 2014 Mar 27;19:149-52. doi: 10.12659/AOT.890213.
When BA patients with end-stage liver dysfunction have bowel obstruction, especially strangulated internal hernia, selecting optimal surgical therapeutic options is crucial.
An 11-month-old female with end-stage biliary atresia (BA) was admitted for a strangulated internal hernia at the Roux-en Y limb and frequent episodes of gastrointestinal bleeding requiring blood transfusion. She was scheduled within a month to receive a portion of the liver from her blood-type identical mother. Despite intensive care, her clinical condition obviously needed a prompt surgical intervention. The operative findings at laparotomy revealed exudative moderate ascites and a dilated and ischemic afferent loop that was strangulated by a band extending from the mesentery to the transverse mesocolon. The attachment of the band was released, and gangrenous changes were recognized in the incarcerated bowel, although there were no obvious findings of intestinal perforation. After the gangrenous afferent loop was resected, the remnant afferent loop was too short to anastomose again. Following these procedures, as the patient's vital signs remained stable, we decided to simultaneously perform living donor liver transplantation (LDLT). She successfully underwent LDLT and her post-transplant course was uneventful.
When faced with candidates for LT as an urgent life-saving surgery, determining whether LDLT should be performed simultaneously during perioperative management is necessary to save the life of the patient.
当患有终末期肝功能不全的胆道闭锁（BA）患者出现肠梗阻，尤其是绞窄性内疝时，选择最佳的手术治疗方案至关重要。
一名11个月大的终末期胆道闭锁女性患者因Roux-en Y肠袢处的绞窄性内疝及频繁发生的需要输血的胃肠道出血入院。她计划在一个月内接受与其血型相同的母亲捐献的部分肝脏。尽管进行了重症监护，但其临床状况显然需要立即进行手术干预。剖腹手术的术中发现显示有渗出性中度腹水以及一个扩张且缺血的输入袢，该输入袢被一条从肠系膜延伸至横结肠系膜的束带绞窄。束带的附着处被松解，尽管没有明显的肠穿孔迹象，但在嵌顿肠段中发现了坏疽性改变。切除坏疽的输入袢后，剩余的输入袢太短无法再次吻合。在这些操作之后，由于患者的生命体征保持稳定，我们决定同时进行活体肝移植（LDLT）。她成功接受了LDLT，术后恢复过程顺利。
当面对作为紧急救命手术的肝移植候选患者时，在围手术期管理中确定是否应同时进行活体肝移植对于挽救患者生命是必要的。
