Kobryń Konrad, Paluszkiewicz Rafał, Dudek Krzysztof, Ołdakowska-Jedynak Urszula, Korba Michał, Raszeja-Wyszomirska Joanna, Remiszewski Piotr, Grąt Michał, Milkiewicz Piotr, Patkowski Waldemar, Krawczyk Marek
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Poland. Banacha Street 1a, 02-097, Warsaw, Poland.
Department of Hepatology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
BMC Surg. 2017 Jan 13;17(1):5. doi: 10.1186/s12893-017-0205-2.
This report presents a case of a 57- year old female with advanced Hepatic Alveolar Echinococcosis causing a secondary Budd-Chiari Syndrome due to infiltration of the suprahepatic inferior vena cava treated successfully by liver transplantation.
A temporary veno-venous bypass was introduced, but a typical end to end cavo-caval anastomosis wasn't possible in this case. In order to access a disease free part of the inferior vena cava, an oval window of the diaphragm was excised, providing communication between the peritoneum and pericardium. A vascular clamp was placed onto the right atrium which allowed for an atrial-caval anastomosis. The remainder of hepatectomy was performed in a conventional manner. In the post-operative period and during the 18 month follow-up there were no complications. The patient remains in good general condition with optimal graft function.
A hepato-atrial anastomosis with a pericardial-peritoneum window during liver transplantation is feasible and extends the curability potential for patients with advanced Hepatic Alveolar Echinococcosis considered for liver transplantation.
本报告介绍了一例57岁女性晚期肝泡型包虫病患者，因肝上下腔静脉受侵导致继发性布加综合征，经肝移植成功治疗。
采用了临时性静脉-静脉转流，但在此病例中无法进行典型的端端腔静脉吻合。为了显露下腔静脉无病变部分，切除了膈肌的椭圆形窗口，使腹膜与心包相通。在右心房放置血管夹，以便进行心房-腔静脉吻合。肝切除术的其余部分按常规方式进行。术后及18个月随访期间无并发症。患者总体状况良好，移植肝功能最佳。
肝移植期间行肝-心房吻合并建立心包-腹膜窗口是可行的，扩大了考虑肝移植的晚期肝泡型包虫病患者的治愈潜力。
