Derksen Wouter J M, de Jong Iris E M, Buis Carlijn I, Reyntjens Koen M E M, Kater G Matthijs, Korteweg Tijmen, Mazuri Aryan, Porte Robert J
Department of Surgery, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
Department of Surgery, Section HPB Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Case Rep Gastroenterol. 2020 Jul 1;14(2):320-328. doi: 10.1159/000508743. eCollection 2020 May-Aug.
Selective portal vein embolization (PVE) before extended liver surgery is an accepted method to stimulate growth of the future liver remnant. Portal vein thrombosis (PVT) of the main stem and the non-targeted branches to the future liver remnant is a rare but major complication of PVE, requiring immediate revascularization. Without revascularization, curative liver surgery is not possible, resulting in a potentially life-threatening situation. We here present a new surgical technique to revascularize the portal vein after PVT by combining a surgical thrombectomy with catheter-based thrombolysis via the surgically reopened umbilical vein. This technique was successfully applied in a patient who developed thrombosis of the portal vein main stem, as well as the left portal vein and its branches to the left lateral segments after selective right-sided PVE in preparation for an extended right hemihepatectomy. The advantage of this technique is the avoidance of an exploration of hepatoduodenal ligament and a venotomy of the portal vein. The minimal surgical trauma facilitates additional intravascular thrombolytic therapy as well as the future right extended hemihepatectomy. We recommend this technique in patients with extensive PVT in which percutaneous less invasive therapies have been proven unsuccessful.
在扩大肝脏手术前进行选择性门静脉栓塞（PVE）是一种公认的刺激未来肝残余体积增大的方法。门静脉主干及未靶向的未来肝残余分支的门静脉血栓形成（PVT）是PVE的一种罕见但严重的并发症，需要立即进行血管重建。如果不进行血管重建，根治性肝脏手术将无法进行，从而导致潜在的危及生命的情况。我们在此介绍一种新的手术技术，通过将手术取栓与经手术重新开放的脐静脉进行基于导管的溶栓相结合，对PVT后的门静脉进行血管重建。该技术成功应用于一名患者，该患者在为扩大右半肝切除术做准备的选择性右侧PVE后，出现了门静脉主干、左门静脉及其至左外侧段分支的血栓形成。该技术的优点是避免了对肝十二指肠韧带的探查和门静脉切开术。最小的手术创伤有利于后续的血管内溶栓治疗以及未来的右半肝扩大切除术。对于经皮微创治疗已被证明无效的广泛PVT患者，我们推荐使用该技术。
