Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Division of HBP Surgery and Liver Transplantation, Department of Surgery, Korea University Medical Center, Korea University Medical College, Seoul, Republic of Korea.
Ann Surg. 2019 Apr;269(4):e43-e45. doi: 10.1097/SLA.0000000000002847.
We aimed to describe our living-donor liver transplantation (LDLT) surgical technique and its long-term patency for patients with Budd-Chiari syndrome (BCS) and retrohepatic inferior vena cava (IVC) obstruction that extends up to the atrium.
From a technical perspective, LDLT for BCS with an IVC obstruction up to the right atrium is one of the most challenging surgical procedures. Consequently, the optimal surgical technique for patients with BCS has not yet been elucidated.
A durable LDLT technique without piggy-back hepatectomy was designed using a large-caliber synthetic interposition vascular graft between the right atrium and the infrahepatic IVC for reconstructing the hepatic outflow tract in patients with BCS.
Between May 2006 and May 2017, 5 of 17 BCS patients who underwent LDLT required the described technique. All patients with a median follow-up of 10.5 years (range, 9.2-11.5 years) demonstrated the patent IVC grafts and no recurrence of BCS.
Our refined technique does not require unnecessary and dangerous dissection of the diseased IVC, and eliminates the residual suprahepatic vena cava with the possibility of BCS recurrence by connecting the graft to the healthy atrium.
我们旨在描述我们的活体肝移植（LDLT）手术技术及其在布加氏综合征（BCS）和肝后下腔静脉（IVC）阻塞患者中的长期通畅性，这些患者的 IVC 阻塞延伸至心房。
从技术角度来看，对于 IVC 阻塞至右心房的 BCS，LDLT 是最具挑战性的手术之一。因此，BCS 患者的最佳手术技术尚未阐明。
我们设计了一种持久的 LDLT 技术，无需劈离式肝切除术，在布加氏综合征患者的右心房和肝下 IVC 之间使用大口径合成介入血管移植物，重建肝流出道。
在 2006 年 5 月至 2017 年 5 月期间，17 例 BCS 患者中有 5 例接受了 LDLT，需要采用描述的技术。所有患者的中位随访时间为 10.5 年（范围为 9.2-11.5 年），均显示 IVC 移植物通畅，BCS 无复发。
我们的改良技术不需要对病变的 IVC 进行不必要和危险的解剖，通过将移植物连接到健康的心房，消除了可能导致 BCS 复发的残余上腔静脉。
