Li Shu-Xuan, Tang He-Nan, Lv Guo-Yue, Chen Xuan
Department of Hepatobiliary and Pancreatic Surgery, the First Hospital of Jilin University, Changchun 130021, Jilin Province, China.
Department of Neurosurgery, the First Hospital of Jilin University, Changchun 130021, Jilin Province, China.
World J Clin Cases. 2022 Apr 26;10(12):3834-3841. doi: 10.12998/wjcc.v10.i12.3834.
Use of liver allograft with hepatic hemangioma after resection of hemangioma in living donor liver transplantation (LDLT) has been previously reported. However, there are few reports describing backtable resection of hemangioma from liver allografts in LDLT.
A 55-year-old male was evaluated as a donor for an 8-month-year old patient with acute hepatic failure due to biliary atresia. Pre-operative contrast enhanced computed tomography revealed a 9 cm hemangioma in segment 4 with vascular variations in the donor. During LDLT, an intra-operative intrahepatic cholangiography was performed to ensure no variation in the anatomy of the intrahepatic bile duct. After intra-operative pathological diagnosis, backtable resection of the hemangioma was performed and the liver allograft was transplanted into the recipient. The donor's and recipient's post-operative course were uneventful. At the 2-year follow-up, the liver allograft showed good regeneration without any recurrence of hemangioma.
Liver allografts with hemangiomas are an acceptable alternative strategy for LDLT. backtable resection of hemangioma from the donor liver during pediatric LDLT is safe and feasible, and can effectively reduce the operative time and intra-operative bleeding for the donor.
此前已有关于活体肝移植(LDLT)中肝血管瘤切除后使用带肝血管瘤的肝移植的报道。然而,关于LDLT中从肝移植供肝进行体外切除血管瘤的报道较少。
一名55岁男性被评估为一名8个月大因胆道闭锁导致急性肝衰竭患者的供体。术前增强CT显示供体肝脏第4段有一个9 cm的血管瘤,且存在血管变异。在LDLT过程中,进行了术中肝内胆管造影以确保肝内胆管解剖结构无变异。术中病理诊断后,对血管瘤进行了体外切除,然后将肝移植供肝植入受体。供体和受体术后过程顺利。在2年随访时,肝移植显示良好的再生,且血管瘤无复发。
带血管瘤的肝移植是LDLT中一种可接受的替代策略。小儿LDLT期间从供体肝脏进行血管瘤体外切除是安全可行的,并且可以有效减少供体的手术时间和术中出血。