PDF(Pubmed)
Abstract：
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 cmH2O to 12 cmH2O. 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.
摘要：
肝脏流出阻塞是活体肝移植后危及生命的事件。在这里，我们抢救了一名患者，该患者因右半肝切除术加尾状叶切除术联合肝中静脉切除术（MHV）后左肝静脉（LHV）弯曲而引起的残留左半肝流出阻塞。8年前，一名50岁的患者在切除右乳腺癌后发现了一个大小为6厘米的肝尾状叶转移瘤，涉及MHV的根部。使用两期肝切除术（部分TIPEALPPS）进行右半肝切除术和尾状叶切除术联合MHV切除术。在第1天，总胆红素值增加到4.5mg/dL，动态计算机断层扫描（CT）扫描显示弯曲的LHV。关于左肝流出阻滞的诊断，使用介入方法将自膨式金属支架放置在LHV中，LHV中的压力从27cmH2O降低到12cmH2O。第3天胆红素值降至1.2mg/dL。扩大右半肝切除术并切除MHV后，可能会发生LHV的流出阻滞。早期诊断和介入支架治疗可以挽救充血性肝衰竭患者。
