Farmer D G, Shaked A, Olthoff K M, Imagawa D K, Millis J M, Busuttil R W
Dumont UCLA Transplant Center, Department of Surgery, UCLA School of Medicine 90024, USA.
Ann Surg. 1995 Jul;222(1):47-50. doi: 10.1097/00000658-199507000-00008.
Biliary atresia, a common indication for liver transplantation, can be associated with situs inversus. Our experience with liver transplantation in children (n = 6) was reviewed retrospectively.
Preoperative duplex sonography, computerized tomography, and visceral angiography were obtained. Vascular anomalies identified included preduodenal portal vein (6/6), interrupted inferior vena cava (5/6), and aberrant hepatic artery (4/6).
The liver graft was placed in a midline position. Venous continuity was achieved by donor suprahepatic inferior vena cava to recipient hepatic cloaca and direct end-to-end portal anastomosis. The donor infrahepatic inferior vena cava was oversewn. Arterial continuity was restored using either a direct branch-patch anastomosis (3/6) or a supraceliac aortic interposition graft (3/6). In retrospect, preoperative diagnostic work-up was noncontributory and outcome was not complicated by pre-existing situs inversus.
Situs inversus in liver recipients requires operative technical modifications, but does not change outcome. Furthermore, extensive preoperative work-up should be avoided.
胆道闭锁是肝移植的常见适应症，可伴有内脏转位。我们回顾性分析了6例儿童肝移植的经验。
术前行双功超声、计算机断层扫描和内脏血管造影检查。发现的血管异常包括十二指肠前门静脉（6/6）、下腔静脉中断（5/6）和肝动脉异常（4/6）。
肝移植置于中线位置。通过供体肝上下腔静脉与受体肝泄殖腔吻合以及门静脉直接端端吻合实现静脉连续性。供体肝下下腔静脉缝闭。使用直接分支补片吻合（3/6）或腹腔动脉上主动脉间置移植（3/6）恢复动脉连续性。回顾性分析发现，术前诊断检查并无帮助，且既往内脏转位并未使结局复杂化。
肝移植受体的内脏转位需要手术技术调整，但不改变结局。此外，应避免进行广泛的术前检查。
