异体血管重建肝静脉流出道在离体肝切除并自体肝移植术中的运用体会  

Application of hepatic outflow reconstruction with allograft vascular in ex-vivo liver resection and autologous liver transplantation

作　　者：田明武 张宇 邓绍平 杨冲 杨洪吉 刘军 周果 邹斌 TIAN Mingwu;ZHANG Yu;DENG Shaoping;YANG Chong;YANG Hongji;LIU Jun;ZHOU Guo;ZOU Bin(Southwest Medical University Clinical Medicine College,Luzhou,Sichuan 646000,P.R.China;Organ Transplantation Center,Sichuan Provincial People’s Hospital,University of Electronic Science and Technology of China,Chengdu 610072,P.R.China;Department of Ultrasound,Sichuan Provincial People’s Hospital,University of Electronic Science and Technology of China,Chengdu 610072,P.R.China;Center for Disease Control and Prevention of Shiqu County,Shiqu,Sichuan 627350,P.R.China)

机构地区：[1]西南医科大学临床医学院,四川泸州646000 [2]电子科技大学附属医院·四川省人民医院器官移植中心,成都610072 [3]电子科技大学附属医院·四川省人民医院超声科,成都610072 [4]石渠县疾病预防控制中心,四川石渠627350

出　　处：《中国普外基础与临床杂志》2020年第7期861-866,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川省卫生计生委课题(项目编号:130134、150192);四川省医学科学院(四川省人民医院)临床研究及转化基金(项目编号:2017LY04)。

摘　　要：目的探讨异体血管重建肝静脉流出道在离体肝切除并自体肝移植术中运用的效果。方法回顾性分析四川省人民医院器官移植中心2019年8月收治的1例行离体肝切除并自体肝移植联合异体血管重建的晚期复杂肝包虫患者的临床资料。结果患者为44岁女性,因"右侧腹部疼痛伴皮肤、巩膜黄染6+个月且加重20+d"入四川省人民医院。患者入院时一般情况差,如高胆红素、低蛋白血症等,体质量45 kg,标准肝体积为852 mL。包虫病灶侵蚀第一、二肝门、肝右静脉及肝后下腔静脉,肝静脉流出道在体重建困难,肝包虫病灶完全在体切除也极为困难。患者入院后经PTCD减黄治疗后一般情况良好,经讨论并严格评估后需采用离体肝切除联合自体肝移植手术。手术时间为15 h,术中出血量约为2 000 mL。术后行常规治疗,继续抗病毒治疗,监测国际标准化比率值在1.5~2.5,无需服用抗免疫排斥药物。患者术后第4天转回普通病房,无胆汁漏、出血、感染等并发症发生。术后病理学诊断:泡性棘球蚴病。术后1周复查增强CT提示,异体血管重建的肝脏流出道通畅,无狭窄,无血栓形成,患者目前在随访中。结论采用自体肝移植术治疗复杂肝包虫病,肝静脉流出道重建宜采取个体化策略;异体静脉因管径长度匹配、无需抗排斥、低感染风险等优点可作为重建肝静脉流出道的理想材料。Objective To explore the effect of hepatic outflow reconstruction with allograft vascular in ex-vivo liver resection and autologous liver transplantation. Method The clinical data of a patient with end-stage hepatic alveolar echinococcosis admitted to the Organ Transplantation Center of Sichuan Provincial People’s Hospital in August 2019 who underwent the ex-vivo liver resection and autologous liver transplantation combined with hepatic vein reconstruction with allograft vascular were analyzed retrospectively. Results The patient, a 44-year-old female, was admitted to Sichuan Provincial People’s Hospital for "pain in the right abdomen accompanied by skin and sclera yellow staining for 6+ months and aggravated for 20+ d". When the patient was admitted, the general condition was poor, such as hyperbilirubin and hypoproteinemia. The body mass was 45 kg and the standard liver volume was 852 mL.The hydatid lesions corroded the first and second hilum of the liver, the right hepatic vein and the posterior inferior vena cava. It was difficult to reconstruct the outflow tract of the hepatic vein in vivo, and it was extremely difficult to completely remove the hydatid lesions in vivo. After admission, the patient was generally in a good condition after the PTCD treatment, then after discussion and rigorous evaluation, the ex-vivo hepatectomy combined with autologous liver transplantation was required. The operative time was 15 h and the intraoperative blood loss was approximately 2 000 mL.After the operation, the routine treatment was performed, the antiviral treatment was continued, the international standardized ratio value was monitored at 1.5–2.5, and the anti-immune rejection drugs were not needed. The patient was transferred to the general ward on the 4 th day after the operation, and there were no bile leakage, bleeding,infection and other complications. the result of postoperative pathological diagnosis was the alveolar echinococcosis.The re-examination of enhanced CT on 1 week after the operation suggested t

关 键 词：肝泡型包虫病 同种异体血管 肝静脉流出道重建 自体肝移植 离体肝切除 

分 类 号：R657.3[医药卫生—外科学]