Lauterio Andrea, De Carlis Riccardo, Di Sandro Stefano, Ferla Fabio, Buscemi Vincenzo, De Carlis Luciano
Division of General Surgery and Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy.
World J Hepatol. 2017 Aug 28;9(24):1022-1029. doi: 10.4254/wjh.v9.i24.1022.
The place of liver transplantation in the treatment of severe iatrogenic liver injuries has not yet been widely discussed in the literature. Bile duct injuries during cholecystectomy represent the leading cause of liver transplantation in this setting, while other indications after abdominal surgery are less common. Urgent liver transplantation for the treatment of severe iatrogenic liver injury may-represent a surgical challenge requiring technically difficult and time consuming procedures. A debate is ongoing on the need for centralization of complex surgery in tertiary referral centers. The early referral of patients with severe iatrogenic liver injuries to a tertiary center with experienced hepato-pancreato-biliary and transplant surgery has emerged as the best treatment of care. Despite widespread interest in the use of liver transplantation as a treatment option for severe iatrogenic injuries, reported experiences indicate few liver transplants are performed. This review analyzes the literature on liver transplantation after hepatic injury and discusses our own experience along with surgical advances and future prospects in this uncommon transplant setting.
肝移植在治疗严重医源性肝损伤中的地位在文献中尚未得到广泛讨论。胆囊切除术中的胆管损伤是这种情况下肝移植的主要原因，而腹部手术后的其他适应证则较少见。紧急肝移植治疗严重医源性肝损伤可能是一项手术挑战，需要技术难度大且耗时的操作。关于复杂手术是否需要集中在三级转诊中心进行的争论仍在继续。将严重医源性肝损伤患者尽早转诊至有经验的肝胰胆和移植手术的三级中心已成为最佳治疗方案。尽管人们对将肝移植作为严重医源性损伤的治疗选择普遍感兴趣，但报道的经验表明进行肝移植的案例很少。本综述分析了肝损伤后肝移植的文献，并讨论了我们自己的经验以及这种罕见移植情况下的手术进展和未来前景。
