Zhang Yu, Xie Ping, Yang Chong, Yang Hongji, Liu Jun, Zhou Guo, Deng Shaoping, Lau Wan Yee
Organ Transplantation Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Clinical Medicine, University of Electronic Science and Technology of China, Chengdu 610072, Sichuan, China.
Ultrasonography Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Clinical Medicine, University of Electronic Science and Technology of China, Chengdu 610072, Sichuan, China.
Int J Surg Case Rep. 2020;68:251-256. doi: 10.1016/j.ijscr.2020.03.004. Epub 2020 Mar 9.
Infiltration of hepatic venous outflow in hepatic alveolar echinococcosis can lead to development of Budd-Chiari syndrome. Medical treatment of this condition is generally unsatisfactory. Radical hepatic resection is impossible for extensive parasitic involvement of liver. This is a case report on a patient who was successfully treated with percutaneous stenting of left hepatic vein followed by Ex vivo Liver Resection and Autotransplantation (ELRA).
Using the transjugular approach, a metal mesh stent was placed in the left hepatic vein of a 45-year-old man who presented with Budd-Chiari syndrome. After disappearance of ascites and improvement in liver function, Ex vivo Liver Resection and Autotransplantation were performed.
The patient underwent left hepatic vein stenting for Budd-Chiari syndrome without complication. Three months later, liver biopsy showed fibrous proliferation of interlobular portal areas and normal hepatic lobules. After successful Ex vivo Liver Resection and Autotransplantation, follow-up examination at 6 months showed normal liver function and no evidence of recurrence.
Allotransplantation is an accepted treatment for advanced hepatic alveolar echinococcosis with Budd-Chiari syndrome. However, shortage of organ donors and need for immunosuppression are challenging problems. In selected patients with hepatic vein stenoses presenting as Budd-Chiari syndreme, percutaneous stenting of hepatic veins followed by ex vivo liver resection and autotransplantation represent an alternative curative treatment option.
肝泡型包虫病中肝静脉流出道受侵可导致布加综合征的发生。该疾病的药物治疗通常效果不佳。对于肝脏广泛受寄生虫累及的情况，根治性肝切除术无法实施。本文报告了一例患者，其经皮肝左静脉支架置入术，随后行离体肝切除及自体肝移植（ELRA）治疗成功。
采用经颈静脉途径，为一名患有布加综合征的45岁男性在肝左静脉置入金属网状支架。腹水消失且肝功能改善后，实施离体肝切除及自体肝移植。
该患者接受了布加综合征的肝左静脉支架置入术，无并发症发生。三个月后，肝脏活检显示小叶间门静脉区纤维组织增生，肝小叶正常。成功实施离体肝切除及自体肝移植后，6个月的随访检查显示肝功能正常，无复发迹象。
同种异体肝移植是晚期肝泡型包虫病合并布加综合征的一种公认治疗方法。然而，器官供体短缺及免疫抑制需求是具有挑战性的问题。对于表现为布加综合征的肝静脉狭窄的特定患者，肝静脉经皮支架置入术，随后行离体肝切除及自体肝移植是一种替代性的根治性治疗选择。
