Kawaguchi Shohei, Onozawa Shiro, Momose Hirokazu, Matsuki Ryota, Kogure Masaharu, Suzuki Yutaka, Sakamoto Yoshihiro
Department of Hepato-Biliary-Pancreatic Surgery, Kyorin University Hospital, Tokyo, Japan.
Department of Radiology, Kyorin University Hospital, Tokyo, Japan.
Glob Health Med. 2024 Jun 30;6(3):222-224. doi: 10.35772/ghm.2023.01105.
Outflow block of the liver is a life-threatening event after living donor liver transplantation. Herein, we rescued a patient suffering from the outflow block of the remnant left hemiliver caused by bending of the left hepatic vein (LHV) after right hemihepatectomy plus caudate lobectomy combined with resection of the middle hepatic vein (MHV). A metastatic tumor sized 6 cm in the caudate lobe of the liver involving the root of the MHV was found in a 50's year old patient after resection of a right breast cancer eight years ago. Right hemihepatectomy and caudate lobectomy combined with resection of the MHV was performed using a two-stage hepatectomy (partial TIPE ALPPS). On day 1, the total bilirubin value increased to 4.5 mg/dL, and a dynamic computed tomography (CT) scan showed the bent LHV. On the diagnosis of outflow block of the left liver, a self-expandable metallic stent was placed in the LHV using an interventional approach, and the pressure in the LHV decreased from 27 cmHO to 12 cmHO. The bilirubin value decreased to 1.2 mg/dL on day 3. Outflow block of the LHV can happen after extended right hemihepatectomy with resection of the MHV. Early diagnosis and interventional stenting treatment can rescue the patient from congestive liver failure.
肝流出道梗阻是活体肝移植术后的一种危及生命的情况。在此，我们成功救治了一名患者，该患者在右半肝切除术加尾状叶切除术并切除肝中静脉（MHV）后，因左肝静脉（LHV）弯曲导致残余左半肝出现流出道梗阻。一名50岁的患者在8年前切除右乳腺癌后，在肝尾状叶发现一个6 cm大小的转移瘤，累及MHV根部。采用两阶段肝切除术（部分TIPE ALPPS）进行了右半肝切除术、尾状叶切除术并切除MHV。术后第1天，总胆红素值升至4.5 mg/dL，动态计算机断层扫描（CT）显示LHV弯曲。在诊断为左肝流出道梗阻后，采用介入方法在LHV置入自膨式金属支架，LHV压力从27 cmH₂O降至12 cmH₂O。术后第3天，胆红素值降至1.2 mg/dL。在扩大右半肝切除术并切除MHV后，LHV可能发生流出道梗阻。早期诊断和介入性支架治疗可使患者免于发生充血性肝衰竭。
