Fernandes Eduardo de Souza Martins, de Mello Felipe Pedreira Tavares, Andrade Ronaldo Oliveira, Girao Camila Liberato, Pimentel Leandro Savattone, Cesar Camilla, Sousa Claudia Cristina, Brito-Azevedo Anderson, Basto Samanta Teixeira, Torres Orlando Jorge Martins
Department of Gastrointestinal and Liver Transplant Surgery, Rio de Janeiro Adventista Hospital, Rio de Janeiro, RJ, Brazil.
Department of Surgery, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Am J Case Rep. 2018 Nov 9;19:1338-1341. doi: 10.12659/AJCR.911694.
BACKGROUND The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is an important tool to induce fast liver hypertrophy. The degree of hepatic fibrosis/cirrhosis in patients with HCC negatively impacts their health, and the risk of liver failure is always present. In these cases, liver transplantation may be necessary as a rescue procedure. We present the case of a patient with HCC who underwent ALPPS and developed liver failure. A living donor liver transplant was performed as a rescue procedure. CASE REPORT A 49-year-old man with chronic hepatitis B without cirrhosis underwent computed tomography, which revealed an expansive lesion in the right lobe of his liver that was diagnosed as hepatocellular carcinoma. Liver resection was indicated and liver cirrhosis was observed with high portal pressure after transection. The treatment strategy was switched from right hepatectomy to ALPPS. The patient developed severe liver dysfunction and liver transplantation was indicated. His postoperative course was uneventful and 3 months after the procedure the patient was without complications. CONCLUSIONS Living donor liver transplantation may be necessary as a rescue procedure for patients who underwent ALPPS and develop liver dysfunction.
背景 联合肝脏分隔和门静脉结扎分期肝切除术（ALPPS）是诱导肝脏快速肥大的一项重要技术。肝癌患者的肝纤维化/肝硬化程度对其健康有负面影响，且始终存在肝衰竭风险。在这些情况下，肝移植可能作为一种挽救措施是必要的。我们报告一例接受ALPPS后发生肝衰竭的肝癌患者病例。作为挽救措施，实施了活体供肝肝移植。病例报告 一名49岁慢性乙型肝炎无肝硬化男性接受计算机断层扫描，显示其肝脏右叶有一占位性病变，诊断为肝细胞癌。因有肝切除指征，且在肝横断术后观察到肝硬化伴门静脉高压。治疗策略从右半肝切除改为ALPPS。患者出现严重肝功能障碍，遂有肝移植指征。其术后过程平稳，术后3个月患者无并发症。结论 对于接受ALPPS后出现肝功能障碍的患者，活体供肝肝移植可能作为一种挽救措施是必要的。
