Czerwonko Matias E, Pekolj Juan, Mattera Juan, Peralta Oscar A, García-Mónaco Ricardo D, de Santibañes Eduardo, de Santibañes Martín
Department of General Surgery, Division of HPB Surgery and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina.
Department of Radiology, Division of Interventional Radiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Langenbecks Arch Surg. 2019 Feb;404(1):123-128. doi: 10.1007/s00423-018-1741-7. Epub 2018 Dec 15.
Pediatric living donor liver transplantation (LDLT) in low weight recipients remains one of the most complex surgical procedures, with portal vein (PV) complications occurring in up to 19% of cases. When decreased PV flow is diagnosed intra- or perioperatively, intraoperative stent placement is a good substitute for surgical adjustment. Still, at the present moment, little is known about the technical feasibility, safety, efficacy, and long-term outcome of intraoperative stenting in LDLT.
Between 2006 and 2017, seven pediatric recipients underwent PV stent placement during the transplant or in the immediate post-operative setting. Preoperative, operative, and post-operative parameters were documented retrospectively.
In total, nine stents were placed in seven patients. Procedures were technically successful in all patients. During the mean imaging follow-up period of 1313 days, none of the patients showed PV abnormality and PV stent remained patent throughout the post-transplant course. There were no deaths or graft loses during the follow-up period.
Intraoperative stenting through the inferior mesenteric vein approach offers both a high feasibility and satisfactory results, with the potential for excellent long-term primary patency despite continued growth in children.
低体重受者的小儿活体肝移植（LDLT）仍然是最复杂的外科手术之一，门静脉（PV）并发症发生率高达19%。当在术中或围手术期诊断出门静脉血流减少时，术中放置支架是手术调整的良好替代方法。然而，目前对于小儿活体肝移植术中支架置入的技术可行性、安全性、有效性和长期结果知之甚少。
2006年至2017年间，7名小儿受者在移植期间或术后即刻接受了门静脉支架置入。回顾性记录术前、术中和术后参数。
7名患者共置入9个支架。所有患者手术均获技术成功。在平均1313天的影像随访期内，所有患者均未出现门静脉异常，门静脉支架在移植后的整个过程中均保持通畅。随访期间无死亡或移植物丢失。
通过肠系膜下静脉途径进行术中支架置入具有很高的可行性和令人满意的结果，尽管儿童持续生长，但仍有可能实现出色的长期原发性通畅。
