Département de Chirurgie Hépato-pancréato-biliaire, AP-HP Hôpital Beaujon, Clichy, France.
Département de Chirurgie hépatobiliaire, Hôpital Estaing, CHU Clermont-Ferrand, France.
Transplantation. 2019 Jul;103(7):1414-1417. doi: 10.1097/TP.0000000000002538.
Liver transplantation (LT) for polycystic liver disease (PLD) is rare, extremely challenging and hemorrhagic, without standard approach. Moreover, LT for PLD presents the highest mortality rate (12% to 18%) among all causes of LT. In this setting, the combination of difficult mobilization of a heavy polycystic native liver with narrow access to inferior vena cava and fragile venous wall may lead to venous tearing and cataclysmic bleeding during dissection. The aim of this study was to evaluate a modified technique of total hepatectomy to limit hazardous liver manipulation and improve exposure of inferior vena cava in patients with massive hepatomegaly related to PLD: the exposure left lateral sectionectomy (ELLS).
From 2011 to 2018, ELLS was performed during LT for PLD. Key technical points for safe and fast ELLS include avoidance of left triangular ligament section and placement of a tape behind the left lateral section allowing its ascension and prior dissection of the hepatic pedicle to limit bleeding. The transection plane is mainly composed of cysts, with limited parenchyma, which allows for rapid and bloodless transection using electric scalpel.
Fifteen patients had ELLS with no postoperative death or intraoperative complication. Median ELLS duration was 16 minutes, and no massive bleeding occurred during this step. During total hepatectomy, median blood loss was 500 mL, and no patient required total caval clamping. All patients were alive at the end of the follow-up.
ELLS during LT for PLD facilitates total hepatectomy with vena cava and caval flow preservation.
肝移植（LT）治疗多囊肝病（PLD）较为罕见，极具挑战性且易出血，目前尚无标准方法。此外，PLD 患者 LT 的死亡率最高（12%-18%）。在此背景下，大量多囊肝的原位肝脏难以移动，下腔静脉通路狭窄且静脉壁脆弱，在解剖过程中可能导致静脉撕裂和灾难性出血。本研究旨在评估一种改良的全肝切除术技术，以限制危险的肝脏操作并改善多囊肝病巨大肝肿大患者下腔静脉的显露：左外侧叶切除术（ELLS）。
2011 年至 2018 年，在 PLD 的 LT 中进行了 ELLS。安全快速进行 ELLS 的关键技术要点包括避免横断左三角韧带，并在左外侧叶后面放置一条带子以允许其上升，以及预先解剖肝蒂以限制出血。横断平面主要由囊肿组成，实质有限，这允许使用电刀快速无血横断。
15 例患者行 ELLS，无术后死亡或术中并发症。ELLS 的中位时间为 16 分钟，此步骤无大出血发生。在全肝切除术中，中位出血量为 500ml，无患者需要全腔静脉阻断。所有患者在随访结束时均存活。
在 PLD 的 LT 中进行 ELLS 有助于在保留腔静脉和腔静脉血流的情况下进行全肝切除术。
