Aktas H, Ozer A, Guner O S, Gurluler E, Emiroglu R
Organ Transplantation Department, Acibadem Bursa Hospital, Bursa, Turkey.
Organ Transplantation Department, Acibadem Atakent University Hospital, Istanbul, Turkey.
Transplant Proc. 2017 Oct;49(8):1820-1823. doi: 10.1016/j.transproceed.2017.06.029.
Despite technical developments in transplantation surgery, complete portal vein thrombosis still remains a challenge for restoration of adequate portal vein inflow. Renoportal or varicoportal anastomosis provides an effective alternative solution for patients with complete portal vein thrombosis. This study describes our experience with renoportal and varicoportal anastomosis during liver transplantation.
Between January 2014 and May 2016, 5 patients with complete portal vein thrombosis underwent extra-anatomic portal anastomosis. In 3 cases, varicoportal anastomosis was performed and for the others, end-to-end renoportal anastomosis. We used iliac cryopreserved vein grafts to restore portal anastomosis in 3 cases. Epidemiology, risk factors, surgical techniques, complications, and outcomes of these procedures were evaluated over short- and long-term follow-ups.
The follow-up time is 3 years for our first renoportal case, which was performed in a cadaveric liver transplantation; it was also first nationwide case. The other renoportal anastomosis was practiced in a living donor liver transplantation and the follow-up time is 8 months. The patient and graft survival rates were 100% at the last follow-up. The follow-up times are 10.9 and 4 months for the patients with varicoportal anastomosis. One of these patients died due to recurrence of hepatocellular carcinoma. The other two patients are alive with good graft functions.
Our experience suggests that reno-varicoportal anastomosis is a useful technique for patients with complete portal vein thrombosis and cryopreserved grafts may be safely used.
尽管移植手术技术有所发展，但完全门静脉血栓形成仍然是恢复足够门静脉血流的一项挑战。肾门静脉或曲张门静脉吻合术为完全门静脉血栓形成的患者提供了一种有效的替代解决方案。本研究描述了我们在肝移植期间进行肾门静脉和曲张门静脉吻合术的经验。
2014年1月至2016年5月期间，5例完全门静脉血栓形成患者接受了解剖外门静脉吻合术。3例进行了曲张门静脉吻合术，其他患者进行了端到端肾门静脉吻合术。3例患者我们使用了冷冻保存的髂静脉移植物来恢复门静脉吻合。通过短期和长期随访评估这些手术的流行病学、危险因素、手术技术、并发症及结果。
我们首例肾门静脉吻合术是在尸体肝移植中进行的，随访时间为3年，这也是全国首例。另一例肾门静脉吻合术是在活体供肝肝移植中进行的，随访时间为8个月。最后一次随访时患者和移植物存活率均为100%。曲张门静脉吻合术患者的随访时间分别为10.9个月和4个月。其中1例患者因肝细胞癌复发死亡。另外2例患者存活，移植物功能良好。
我们的经验表明，肾曲张门静脉吻合术对完全门静脉血栓形成患者是一种有用的技术，冷冻保存的移植物可以安全使用。
