经腹腔心包路径肝上下腔静脉与右心房吻合肝移植治疗布-加综合征合并肝癌1例附手术视频

Transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium in liver transplantation for Budd-Chiari syndrome complicated with liver cancer:a case report with surgical video

目的总结经腹腔心包路径供肝肝上下腔静脉与受者右心房吻合肝移植治疗布-加综合征(BCS)合并肝癌的相关经验。方法回顾性分析1例经腹腔心包路径肝上下腔静脉与右心房吻合肝移植治疗BCS合并肝癌病例的临床资料。结果患者的肝静脉和肝上下腔静脉局部闭塞,在心脏不停跳情况下,采用经腹腔心包路径完成肝上下腔静脉与右心房吻合肝移植,此外,由于受者肝动脉病变,采用受者脾动脉切断,远端结扎,近端反转与供肝肝总动脉吻合,完成肝动脉重建,手术过程顺利。术后1周左右移植肝肝功能逐步恢复正常,无重大并发症发生。患者术后25 d出院,随访8个月余无BCS复发征象。结论经腹腔心包路径肝上下腔静脉与右心房吻合肝移植治疗BCS是安全可行的,对于合并肝癌的患者预后较好。

Objective To summarize clinical experience of transabdominal pericardial anastomosis of suprahepatic vena cava of the donor and right atrium of the recipient in liver transplantation for Budd-Chiari syndrome(BCS)complicated with liver cancer.Methods Clinical data of a BCS patient complicated with liver cancer undergoing transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium in liver transplantation were retrospectively analyzed.Results The hepatic vein and suprahepatic vena cava were partially occluded in the patient.Liver transplantation was completed by transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium with beating-heart.In addition,due to pathological changes of the recipient's hepatic artery,splenic artery of the recipient was cut off,distal ligation was performed,and the proximal end was reversed and anastomosed with the common hepatic artery of the donor liver,and the reconstruction of hepatic artery was completed.The surgery was successfully performed.At approximately postoperative 1 week,the function of the liver allograft was gradually restored to normal,and no major complications occurred.The patient was discharged at postoperative 25 d.No signs of BCS recurrence was reported after 8-month follow-up.Conclusions It is safe and feasible to treat BCS by liver transplantation with transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium.BCS patients complicated with liver cancer obtain favorable prognosis.