Elariny H A, Mizrahi S S, Hayes D H, Boudreaux J P, Hussey J L, Farr G H
Department of Surgery, Ochsner Clinic, New Orelans, LA 70121.
Transpl Int. 1994 Jul;7(4):309-13. doi: 10.1007/BF00327162.
Nodular regenerative hyperplasia of the liver is an uncommon cause of portal hypertension. Patients with nodular regenerative hyperplasia have signs and symptoms of portal hypertension, without evidence of hepatocellular failure or encephalopathy. We report the case of a 44-year-old woman with recurrent esophageal bleeding and refractory ascites who had a history of hemosiderosis, hepatitis C, and chronic renal allograft rejection. Our preoperative diagnosis was cirrhotic end-stage liver disease and end-stage renal disease for which the patient underwent combined hepatic and renal transplantation. Her portal hypertension symptoms resolved, and her renal function has been normal for 18 months of follow-up. Histologic examination of the liver revealed nodular regenerative hyperplasia, and a review of the literature regarding the surgical management of patients with nodular regenerative hyperplasia revealed that various shunting procedures are generally recommended. After the failure of medical management in patients with nodular regenerative hyperplasia, portosystemic shunting may be indicated before proceeding to hepatic transplantation.
肝脏结节性再生性增生是门静脉高压的一种罕见病因。患有结节性再生性增生的患者具有门静脉高压的体征和症状，而无肝细胞衰竭或肝性脑病的证据。我们报告了一例44岁女性患者，她反复出现食管出血和难治性腹水，有血色素沉着症、丙型肝炎和慢性肾移植排斥反应病史。我们的术前诊断为肝硬化终末期肝病和终末期肾病，该患者接受了肝肾联合移植。她的门静脉高压症状得到缓解，在18个月的随访中肾功能一直正常。肝脏组织学检查显示为结节性再生性增生，回顾有关结节性再生性增生患者手术治疗的文献发现，一般推荐各种分流手术。对于结节性再生性增生患者药物治疗失败后，在进行肝移植之前可能需要进行门体分流术。
