Lim Chetana, Osseis Michael, Tudisco Antonella, Lahat Eylon, Sotirov Dobromir, Salloum Chady, Azoulay Daniel
Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France.
Université Paris-Est UPEC, Créteil, France.
Ann Hepatobiliary Pancreat Surg. 2018 Nov;22(4):321-325. doi: 10.14701/ahbps.2018.22.4.321. Epub 2018 Nov 27.
BACKGROUNDS/AIMS: Preservation of the native inferior vena cava using a large graft during adult whole liver transplantation is associated with a potential risk of hepatic venous outflow compression/obstruction, which may adversely affect both graft and short-term patient outcomes. Intraoperative placement of materials to restore adequate hepatic venous outflow can overcome this complication.
Data of patients who underwent liver transplantation between 2011 and 2016 were retrospectively reviewed. All cases of hepatic venous outflow obstruction due to large graft size managed via intraoperative intervention were analyzed. The literature was searched for studies reporting adult cases of hepatic venous outflow obstruction following whole liver transplantation managed extrahepatically.
Three patients diagnosed with intraoperative hepatic venous outflow obstruction due to large graft size were managed via retro-hepatic placement of breast implants (2 cases) or abdominal pads (1 case). It was successfully carried out in all cases. Four studies including 15 patients were identified in the literature search. Different types of materials such as inflatable materials (Foley catheter, Blakemore balloon), surgical gloves or breast implants, were used.
Placement of inflatable materials leads to gradual deflation in the postoperative period, which might obviate the need for reoperation. Breast implants could be left in place indefinitely due to their bio-inert nature.
背景/目的：在成人全肝移植期间使用大口径移植物保留原生下腔静脉与肝静脉流出道受压/梗阻的潜在风险相关，这可能对移植物和患者短期预后产生不利影响。术中放置材料以恢复足够的肝静脉流出道可克服这一并发症。
回顾性分析2011年至2016年间接受肝移植患者的数据。分析所有因移植物尺寸大导致肝静脉流出道梗阻并通过术中干预处理的病例。检索文献，查找报告肝外处理成人全肝移植后肝静脉流出道梗阻病例的研究。
3例因移植物尺寸大被诊断为术中肝静脉流出道梗阻的患者通过在肝后放置乳房植入物（2例）或腹部垫（1例）进行处理。所有病例均成功实施。在文献检索中确定了4项研究，共15例患者。使用了不同类型的材料，如可充气材料（福勒导尿管、布莱克莫尔球囊）、手术手套或乳房植入物。
放置可充气材料会在术后逐渐放气，这可能无需再次手术。乳房植入物因其生物惰性可无限期留置。
