Kinaci Erdem, Kayaalp Cuneyt, Yilmaz Sezai, Otan Emrah
Inonu University, Liver Transplantation Institute, 44280 Malatya, Turkey ; Istanbul Training and Research Hospital, Department of General Surgery, 34098 Istanbul, Turkey.
Inonu University, Liver Transplantation Institute, 44280 Malatya, Turkey.
Case Rep Transplant. 2014;2014:740802. doi: 10.1155/2014/740802. Epub 2014 May 21.
Hepatic venous outflow obstruction following liver transplantation is rare but disastrous. Here we described a 14-year-old boy who underwent a split right lobe liver transplantation with modified (side-to-side) piggyback technique which resulted in hepatic venous outflow obstruction. When the liver graft was lifted up, the outflow drainage returned to normal but when it was placed back into the abdomen, the outflow obstruction recurred. Because reanastomosis would have resulted in hepatic reischemia, alternatively, a second infrahepatic cavocavostomy was planned without requiring hepatic reischemia. During this procedure, the first assistant hung the liver up to provide sufficient outflow and the portal inflow of the graft continued as well. We only clamped the recipient's infrahepatic vena cava and the caudal cuff of the graft cava. After the second end-to-side cavocaval anastomosis, the graft was placed in its orthotopic position and there was no outflow problem anymore. The patient tolerated the procedure well and there were no problems after three months of follow-up. A second cavocavostomy can provide an extra bypass for some hepatic venous outflow problems after piggyback anastomosis by avoiding hepatic reischemia.
肝移植后肝静脉流出道梗阻虽罕见但后果严重。在此，我们描述了一名14岁男孩，他接受了改良（侧侧）背驮式技术的右半肝劈离式肝移植，结果发生了肝静脉流出道梗阻。当提起肝移植肝时，流出道引流恢复正常，但当将其放回腹腔时，流出道梗阻又复发。由于再次吻合会导致肝脏再次缺血，因此，计划实施第二次肝下腔静脉吻合术，而无需肝脏再次缺血。在此手术过程中，第一助手提起肝脏以提供足够的流出道，移植肝的门静脉血流也持续存在。我们仅钳夹受者的肝下腔静脉和移植肝腔静脉的尾侧袖套。第二次端侧腔静脉吻合术后，将移植肝置于原位，不再有流出道问题。患者对该手术耐受良好，随访三个月后无任何问题。通过避免肝脏再次缺血，第二次腔静脉吻合术可为背驮式吻合术后的一些肝静脉流出道问题提供额外的旁路。
