Edgerton Colston A, Gross Megan, Kasi Nagraj, Hewitt Winston, Edmondson Sara, Rohan Vinayak S, Nadig Satish N
Department of Surgery, Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC, USA.
Department of Pediatrics, Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC, USA.
Pediatr Transplant. 2018 Aug;22(5):e13218. doi: 10.1111/petr.13218. Epub 2018 May 15.
We present the unique case of a 15-month-old male born with biliary atresia and situs inversus totalis and disrupted inferior vena cava who underwent a successful liver transplantation. The patient had previously undergone a failed Kasai procedure and presented with persistent hyperbilirubinemia. The patient was transplanted with a left lateral segment donor having standard arterial anatomy. Technical considerations included identifying completely replaced arterial anatomy in the recipient from the superior mesenteric artery and creating a branch patch between the gastroduodenal artery and HA, anastomosing the donor left hepatic vein to confluences of the donor left, middle, and right hepatic veins, using a "lazy-S" configuration of portal vein anastomosis, and suspending the allograft to the abdominal wall. Post-operatively, his liver function tests and total bilirubin normalized and he progressed to tolerating an oral diet with tube-feed supplementation.
我们报告了一例独特病例，一名15个月大的男性，出生时患有胆道闭锁、完全性内脏反位以及下腔静脉中断，接受了成功的肝移植手术。该患者此前接受的Kasai手术失败，出现持续性高胆红素血症。患者接受了具有标准动脉解剖结构的左外侧叶供肝移植。技术要点包括从肠系膜上动脉识别受者完全替代的动脉解剖结构，并在胃十二指肠动脉和肝动脉之间创建分支补片，将供体左肝静脉与供体左、中、右肝静脉的汇合处吻合，采用“懒S”形门静脉吻合构型，并将同种异体移植物悬吊于腹壁。术后，他的肝功能检查和总胆红素恢复正常，并逐渐能够耐受口服饮食并辅以管饲。
