Rudroff C, Scheele J
Department of Surgery, Friedrich-Schiller-University, Jena, Germany.
Clin Transplant. 1998 Dec;12(6):538-42.
Portal vein thrombosis (PVT) was previously considered a contraindication to orthotopic liver transplantation (OLT) since adequate portal blood supply is mandatory for graft function and patient survival. Improvements in surgical technique, however, have meant that this problem now can be circumvented in most instances. Nevertheless portal vein thrombosis remains an obstacle in OLT and is associated with increased incidence of primary non-function and long-term liver failure.
A 55-yr-old patient underwent OLT for secondary biliary cirrhosis associated with hepatitis C infection and complicated by long standing PVT. Involvement of the portal, mesenteric, and splenic veins prevented standard portal venous reconstruction. Portal inflow was accomplished by a side-to-end anastomosis between the middle colic vein and the donor portal vein.
Hepatic reperfusion and subsequent liver function were excellent. Portal blood flow, as measured by color-enhanced Doppler ultrasound, was normal following surgery until discharge. The post-operative course was complicated by abdominal wound dehiscence and recurrent cytomegalovirus (CMV) infection. The patient was discharged in good clinical condition, with excellent liver function and patent portal vein 89 d after OLT.
The middle colic vein is a novel, not previously described, source of portal venous inflow for OLT complicated by extensive splanchnic venous inflow thrombosis.
门静脉血栓形成（PVT）曾被视为原位肝移植（OLT）的禁忌证，因为充足的门静脉血供对于移植物功能和患者存活至关重要。然而，手术技术的改进意味着现在在大多数情况下这个问题可以被规避。尽管如此，门静脉血栓形成仍然是OLT中的一个障碍，并且与原发性无功能和长期肝衰竭的发生率增加相关。
一名55岁患者因丙型肝炎感染相关的继发性胆汁性肝硬化并伴有长期PVT而接受OLT。门静脉、肠系膜静脉和脾静脉受累使得标准的门静脉重建无法进行。通过中结肠静脉与供体门静脉之间的端侧吻合来实现门静脉血流。
肝脏再灌注及随后的肝功能均良好。术后直至出院，经彩色增强多普勒超声测量的门静脉血流均正常。术后过程因腹部伤口裂开和复发性巨细胞病毒（CMV）感染而复杂化。患者在OLT术后89天临床状况良好出院，肝功能良好且门静脉通畅。
中结肠静脉是OLT合并广泛内脏静脉流入道血栓形成时一种新的、此前未描述过的门静脉血流来源。
