Reimondez S, Alcaraz Á, Giordano Segade E, Agüero Ramaccioni N, Casarez Díaz G, Maraschio M A
Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
Transplant Proc. 2019 Mar;51(2):585-588. doi: 10.1016/j.transproceed.2018.12.002. Epub 2018 Dec 12.
Situs inversus totalis is an infrequent genetic malformation affecting 0.01% of the population and consists of the total rotation of the organs 180 degrees, generating the so-called mirror-image reversal. For many years donors with this pathology were discouraged from organ donation. We present a case of hepatic and renal transplantation using the 2 techniques described, orthotopic and retroversus. The recipient was a 69-year-old man with end-stage liver and kidney disease due to alcoholism and diabetes, respectively, and a Model for End-Stage Liver Disease score of 32. There was no mismatch between recipient and donor. The implant started with the piggy-back technique using the retroversus technique, generating a tense portal vein anastomosis due to the superior situation of the elements of the hepatic hilum, so it was decided to undo suprahepatic anastomosis with the orthotopic technique, rotating the liver on its axis, without complications. Roux-en-Y hepaticojejunoanastomosis was carried out. The patient was discharged 15 days after surgery with normalization of renal function. Although both techniques must be taken into account, the one that fits best for a particular recipient should be used, given the particularities of size and shape of the liver graft. This can take some art and creativity from the surgical team.
全内脏反位是一种罕见的基因畸形，影响着0.01%的人口，其特征是器官整体旋转180度，形成所谓的镜像反转。多年来，患有这种病症的捐赠者一直不被鼓励进行器官捐赠。我们呈现了一例使用所述的两种技术（原位和逆向）进行肝移植和肾移植的病例。受者是一名69岁男性，分别因酗酒和糖尿病导致终末期肝病和肾病，终末期肝病模型评分32分。供受者之间无配型不合。移植手术首先采用逆向技术的背驮式技术，但由于肝门部结构位置较高，导致门静脉吻合口张力较大，因此决定采用原位技术拆除肝上吻合口，将肝脏绕其轴旋转，未出现并发症。进行了Roux-en-Y肝空肠吻合术。患者术后15天出院，肾功能恢复正常。尽管两种技术都应予以考虑，但鉴于肝移植的大小和形状特点，应选择最适合特定受者的技术。这需要手术团队具备一定的技巧和创造力。
