Ara Cengiz, Akbulut Sami, Ince Volkan, Karakas Serdar, Baskiran Adil, Yilmaz Sezai
Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey.
Medicine (Baltimore). 2016 Oct;95(43):e5136. doi: 10.1097/MD.0000000000005136.
The aim of the study was to report the detailed surgical techniques of living donor liver transplantation (LDLT) in patients with Budd-Chiari syndrome (BCS).
Demographic and surgical techniques characteristics of 39 patients with BCS who underwent LDLT were retrospectively reviewed. Thirty-two of them had native vena cava inferior (VCI) preservation and 6 had retrohepatic VCI resection with venous continuity established by cryopreserved VCI (n = 4) or aortic graft (n = 2). In 1 patient, the anastomosis was established between the graft hepatic vein (HV) and the suprahepatic VCI. For preservation of the native VCI, immediately before the graft implantation, the thickened anterior, and right/left lateral walls of the recipient VCI were resected caudally and cranially until the intact vein wall was reached, and then an anastomosis was created between the (HV) of the graft reconstructed as a circumferential fence and the reconstructed recipient VCI. For resection of the retrohepatic VCI, the anastomosis was created with the same technique in all 6 patients in whom VCI was reformed by using a vascular graft.
Post-LT complications developed in 19 of the patients. Complications related to the biliary anastomosis accounted for 12 of these cases, with 11 treated by PTC and/or ERCP, and 1 by hepaticojejunostomy. Two of the 39 patients developed recurrent BCS and were treated by interventional radiological methods. Thirteen patients died and none were related to the BCS recurrence.
Favorable outcomes are achievable with LDLT treatment of patients with BCS, which carries important implications for countries with inadequate cadaveric donor pools.
本研究旨在报告布加综合征（BCS）患者活体肝移植（LDLT）的详细手术技术。
回顾性分析39例行LDLT的BCS患者的人口统计学和手术技术特征。其中32例保留了自体下腔静脉（VCI），6例进行了肝后VCI切除，通过冷冻保存的VCI（n = 4）或主动脉移植物（n = 2）建立静脉连续性。1例患者在移植肝静脉（HV）与肝上VCI之间进行了吻合。为保留自体VCI，在植入移植物前，将受体VCI增厚的前壁和右/左侧壁在尾侧和头侧切除，直至达到完整的静脉壁，然后在重建为环形围栏的移植物的（HV）与重建的受体VCI之间进行吻合。对于肝后VCI切除，在所有6例使用血管移植物重建VCI的患者中，均采用相同技术进行吻合。
19例患者发生了肝移植后并发症。与胆肠吻合相关的并发症占其中12例，11例通过经皮肝穿刺胆管造影（PTC）和/或内镜逆行胰胆管造影（ERCP）治疗，1例通过肝空肠吻合术治疗。39例患者中有2例发生复发性BCS，通过介入放射学方法治疗。13例患者死亡，均与BCS复发无关。
LDLT治疗BCS患者可取得良好疗效，这对尸体供体库不足的国家具有重要意义。
