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术中经食管超声心动图在巨大多囊肝疾病患者肝移植血流动力学管理中的应用：一例报告

Usefulness of intraoperative transesophageal echocardiography for hemodynamic management of liver transplantation in a patient with massive polycystic liver disease: a case report.

作者信息

Ueda Yudai, Kawaji Takahiro, Komura Hidefumi, Hara Yoshitaka, Kuriyama Naohide, Nakamura Tomoyuki, Nishida Osamu

机构信息

Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan.

出版信息

JA Clin Rep. 2023 Aug 26;9(1):54. doi: 10.1186/s40981-023-00646-4.

DOI:10.1186/s40981-023-00646-4
PMID:37626229
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10457252/
Abstract

BACKGROUND

Hemodynamic management during anesthesia in liver transplantation for patients with polycystic liver disease (PLD) can be more challenging because of the bleeding and hemodynamic alterations due to the markedly enlarged liver. We hereby report a case of PLD wherein transesophageal echocardiography (TEE) was employed for optimal hemodynamic monitoring during liver transplantation.

CASE PRESENTATION

A 61-year-old man was scheduled to undergo liver transplantation for massive PLD. Hemodynamic instability was associated with mechanical displacement of the giant cystic liver. TEE results revealed the collapse of the inferior vena cava due to liver displacement. TEE also detected intrathoracic hemorrhage triggered by detachment from the markedly enlarged liver.

CONCLUSION

TEE is a valuable monitoring tool for sharing information with surgeons and diagnostic modality for finding the source of bleeding in liver transplantation for PLD and may contribute majorly to the quality of perioperative management.

摘要

背景

由于多囊肝（PLD）患者肝脏明显肿大导致出血和血流动力学改变，肝移植麻醉期间的血流动力学管理可能更具挑战性。我们在此报告一例PLD患者，在肝移植期间采用经食管超声心动图（TEE）进行最佳血流动力学监测。

病例介绍

一名61岁男性计划因巨大PLD接受肝移植。血流动力学不稳定与巨大囊性肝脏的机械移位有关。TEE结果显示由于肝脏移位导致下腔静脉塌陷。TEE还检测到因与明显肿大的肝脏分离而引发的胸腔内出血。

结论

TEE是一种有价值的监测工具，可用于与外科医生共享信息，也是用于查找PLD肝移植出血源的诊断方式，可能对围手术期管理质量有重大贡献。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5dcd/10457252/b4270bdfc5ca/40981_2023_646_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5dcd/10457252/4899d904170c/40981_2023_646_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5dcd/10457252/cc43c02585cd/40981_2023_646_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5dcd/10457252/b4270bdfc5ca/40981_2023_646_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5dcd/10457252/4899d904170c/40981_2023_646_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5dcd/10457252/cc43c02585cd/40981_2023_646_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5dcd/10457252/b4270bdfc5ca/40981_2023_646_Fig3_HTML.jpg

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本文引用的文献

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Liver transplantation in adult polycystic liver disease: the Ontario experience.成人多囊性肝病的肝移植：安大略省的经验。
BMC Gastroenterol. 2021 Mar 9;21(1):115. doi: 10.1186/s12876-021-01703-x.
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Bleeding Outcomes Following Transesophageal Echocardiography in Patients With Cirrhosis and Esophageal Varices.肝硬化合并食管静脉曲张患者行经食管超声心动图后的出血结局。
Hepatol Commun. 2020 Nov 21;5(2):283-292. doi: 10.1002/hep4.1635. eCollection 2021 Feb.
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Safety and Benefit of Transesophageal Echocardiography in Liver Transplant Surgery: A Position Paper From the Society for the Advancement of Transplant Anesthesia (SATA).
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Polycystic liver disease: Classification, diagnosis, treatment process, and clinical management.多囊肝病：分类、诊断、治疗过程及临床管理。
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Post-Reperfusion Syndrome in Liver Transplantation-An Overview.肝移植中的再灌注综合征——概述
J Cardiothorac Vasc Anesth. 2020 Feb;34(2):501-511. doi: 10.1053/j.jvca.2019.02.050. Epub 2019 Mar 7.
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Modified Technique of Total Hepatectomy in Polycystic Liver Disease With Caval Flow Preservation: The Exposure Left Lateral Sectionectomy.保留腔静脉血流的多囊肝全切除术改良技术：显露左侧外叶切除术。
Transplantation. 2019 Jul;103(7):1414-1417. doi: 10.1097/TP.0000000000002538.
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Liver Transplant for Unusually Large Polycystic Liver Disease: Challenges and Pitfalls.超大多囊肝疾病的肝移植：挑战与陷阱
Case Rep Transplant. 2018 Feb 1;2018:4863187. doi: 10.1155/2018/4863187. eCollection 2018.
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Perioperative transesophageal echocardiography for non-cardiac surgery.非心脏手术的围手术期经食管超声心动图。
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Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists.经食管超声心动图全面检查操作指南：美国超声心动图学会和心血管麻醉医师学会的建议
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