Kawamoto Yusuke, Ome Yusuke, Kawamoto Kazuyuki
Department of General Surgery, Kurashiki Central Hospital, Kurashiki, Japan.
Case Rep Gastroenterol. 2017 May 19;11(2):320-328. doi: 10.1159/000476059. eCollection 2017 May-Aug.
Duplicated inferior vena cava (IVC) is a rare congenital anomaly. We describe the utility of a new graft from the left IVC in a patient with duplicated IVC for reconstructing the middle hepatic vein (MHV) after partial hepatectomy with MHV resection. A 67-year-old woman with hepatitis C was found to have a liver tumor. Magnetic resonance imaging confirmed that the tumor, which was attached to the MHV, was hepatocellular carcinoma. Central bisectionectomy (S4, S5, and S8 resection) could not be tolerated because of poor liver function and a low future liver remnant volume. Therefore, partial hepatectomy with MHV resection was performed. The left IVC was harvested as a venous graft and was substituted for the resected MHV. She recovered uneventfully and was discharged on postoperative day 12. To the best of our knowledge, this is the first report of using the left IVC as a venous graft. The left IVC is a good candidate graft for the MHV or for portal vein reconstruction because of its length, diameter, and easy harvesting (it did not require an extra incision) in a patient with duplicated IVC.
下腔静脉重复畸形是一种罕见的先天性异常。我们描述了在一名下腔静脉重复畸形患者中，使用来自左位下腔静脉的新移植物在肝中叶静脉（MHV）切除术后部分肝切除术中重建MHV的效用。一名67岁丙型肝炎女性被发现患有肝肿瘤。磁共振成像证实，附着于MHV的肿瘤为肝细胞癌。由于肝功能差和未来肝剩余体积小，无法耐受中央二分切除术（S4、S5和S8切除）。因此，进行了肝中叶静脉切除的部分肝切除术。采集左位下腔静脉作为静脉移植物，替代切除的MHV。她恢复顺利，术后第12天出院。据我们所知，这是首次使用左位下腔静脉作为静脉移植物的报告。由于其长度、直径以及在患有下腔静脉重复畸形的患者中易于采集（无需额外切口），左位下腔静脉是MHV或门静脉重建的良好移植物候选。
