Hamura Ryoga, Onda Shinji, Shirai Yoshihiro, Yasuda Jungo, Haruki Koichiro, Furukawa Kenei, Sakamoto Taro, Gocho Takeshi, Ikegami Toru
Division of Hepatobiliary and Pancreas Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
Surg Case Rep. 2022 Jan 4;8(1):3. doi: 10.1186/s40792-021-01357-7.
The administration of direct-acting antiviral agents in patients with liver cirrhosis and hepatitis C has been shown to improve liver function and long-term prognosis after sustained virological response (SVR) is achieved. However, in patients with portal hypertension (PH) at the time of SVR, PH may persist despite improvement in liver function.
An 82-year-old woman with liver cirrhosis due to hepatitis C was treated with direct-acting antiviral agents and achieved SVR. During follow-up, computed tomography revealed a low-density tumor in the left lateral region of the liver with dilation of the left intrahepatic bile duct. Considering the patient's advanced age and PH persistence with a mild decrease in liver reserve function after SVR, preoperative percutaneous transhepatic portal embolization (PTPE) and partial splenic embolization (PSE) were performed concomitantly. Laparoscopic left hemihepatectomy was performed 8 days after the PTPE and PSE. The patient was discharged 8 days after surgery without any postoperative complications.
Laparoscopic left hemihepatectomy after preoperative management of PH was performed safely in a patient after the elimination of hepatitis C.
在肝硬化合并丙型肝炎患者中应用直接抗病毒药物已显示，在实现持续病毒学应答（SVR）后可改善肝功能和长期预后。然而，在SVR时存在门静脉高压（PH）的患者中，尽管肝功能有所改善，但PH可能仍然持续存在。
一名82岁因丙型肝炎导致肝硬化的女性接受了直接抗病毒药物治疗并实现了SVR。在随访期间，计算机断层扫描显示肝左外侧区域有一个低密度肿瘤，左肝内胆管扩张。考虑到患者年龄较大且SVR后PH持续存在，肝脏储备功能轻度下降，术前同时进行了经皮经肝门静脉栓塞术（PTPE）和部分脾栓塞术（PSE）。在PTPE和PSE术后8天进行了腹腔镜左半肝切除术。患者术后8天出院，无任何术后并发症。
在一名丙型肝炎清除后的患者中，术前对PH进行处理后安全地实施了腹腔镜左半肝切除术。
