Dousset B, Legmann P, Soubrane O, Chaussade S, Couturier D, Houssin D, Calmus Y
Department of Surgery, Hôpital Cochin, Paris, France.
J Hepatol. 1997 Jul;27(1):206-10. doi: 10.1016/s0168-8278(97)80303-0.
A 42-year-old man with a history of repeated abdominal surgery and lymph node tuberculosis underwent orthotopic liver transplantation for primary sclerosing cholangitis. Two years after transplantation, this patient developed a severe protein-losing enteropathy with no evidence of cardiac disease or lymphoproliferative disorder. Imaging work-up revealed hemodynamically significant stenosis of the supra-hepatic caval anastomosis, which was treated by percutaneous balloon angioplasty. All clinical and biochemical disorders resolved within 1 month after percutaneous dilatation, but relapsed simultaneously with recurrent anastomotic stenosis 15 months later. Repeat caval angioplasty resulted in rapid recovery, which strongly suggests that hepatic venous outflow obstruction was responsible for the protein-losing enteropathy in this patient.
一名有反复腹部手术和淋巴结结核病史的42岁男性因原发性硬化性胆管炎接受了原位肝移植。移植两年后，该患者出现严重的蛋白丢失性肠病，无心脏病或淋巴增殖性疾病证据。影像学检查显示肝上腔静脉吻合口存在血流动力学显著狭窄，经皮球囊血管成形术对其进行了治疗。经皮扩张后1个月内所有临床和生化紊乱均得到缓解，但15个月后随着吻合口狭窄复发同时复发。再次进行腔静脉血管成形术导致快速恢复，这强烈提示肝静脉流出道梗阻是该患者蛋白丢失性肠病的原因。
