Kisaoglu A, Demiryilmaz I, Dandin O, Yilmaz V T, Aydinli B
Department of General Surgery, Medicine Faculty Hospital, University of Akdeniz, Antalya, Turkey.
Department of Nephrology, Medicine Faculty Hospital, University of Akdeniz, Antalya, Turkey.
Hippokratia. 2019 Jul-Sep;23(3):140-142.
In advanced cirrhotic patients, extensive mesenteric vein thrombosis extends the operative time, causes peri- and postoperative complications, and increases the mortality and morbidity in liver transplantation (LT). The anastomosis between the left renal vein and graft portal vein is one of the crucial options in such patients. However, especially in living donor liver transplantation (LDLT) practice, limited cases are published in the literature.
A thirty-seven years old female patient with hepatitis B virus (HBV) associated liver cirrhosis underwent LDLT. Her body mass index, graft weight, and graft-recipient weight ratio (GRWR) were noted 19.3 kg/m, 990 g, and 1.9 %, respectively. During the surgical procedure, she had renoportal anastomosis (RPA) due to extensive portal vein thrombosis to provide an efficient portal inflow to the transplanted graft. No complication was observed in the early postoperative period, and the one year follow up passed without any problem.
In LT, for providing efficient portal flow to the graft, the RPAs should be considered as an option in case of extensive splanchnic vein thrombosis and large splenorenal shunt. Ensuring that graft volume is close to the recipient standard liver volume, RPA can be performed safely and effectively in LDLT as an acceptable and life-saving procedure. HIPPOKRATIA 2019, 23(3): 140-142.
在晚期肝硬化患者中，广泛的肠系膜静脉血栓形成会延长手术时间，导致围手术期及术后并发症，并增加肝移植（LT）的死亡率和发病率。左肾静脉与移植门静脉之间的吻合术是这类患者的关键选择之一。然而，尤其是在活体肝移植（LDLT）实践中，文献报道的病例有限。
一名37岁的乙型肝炎病毒（HBV）相关性肝硬化女性患者接受了LDLT。她的体重指数、移植肝重量和移植肝与受体体重比（GRWR）分别为19.3kg/m²、990g和1.9%。手术过程中，由于广泛的门静脉血栓形成，她进行了肾门静脉吻合术（RPA），以确保移植肝有有效的门静脉血流。术后早期未观察到并发症，1年随访也无任何问题。
在肝移植中，为确保移植肝有有效的门静脉血流，对于广泛的内脏静脉血栓形成和大的脾肾分流情况，肾门静脉吻合术应被视为一种选择。确保移植肝体积接近受体标准肝体积，肾门静脉吻合术在活体肝移植中可以作为一种可接受的挽救生命的手术安全有效地进行。《希波克拉底》2019年，23(3): 140 - 142。
