肝移植治疗内脏全反位肝癌患者1例及并发症处理

Liver transplantation for a hepatic cancer patient with complete situs inversus and management of complications

目的:应用原位肝移植治疗1例内脏全反位肝癌患者,并探讨术后并发症的处理方法。方法:将正常解剖的供肝绕中线顺时针垂直旋转90°植入患者原位,所有管道吻合口均采取端-端吻合的方法,患者术后随访并积极处理并发症。结果:患者术后恢复良好,5个月出现胆管吻合口狭窄,经内镜下逆行胆管内支架引流(ERBD)和经皮肝穿刺胆管引流(PTCD)治疗后痊愈。随访30个月,移植肝功能正常,肿瘤无复发。结论:内脏全反位肝癌患者可实施原位肝移植治疗,胆道并发症是其主要并发症之一,经过及时处理可获得良好的长期预后。

Objective： To explore the surgical techniques of liver transplantation （LT）for a hepatic cancer patient with complete situs inversus （CSI） and to discuss the post-operation management of complications. Methods： A patient with CSI suffering from hepatocelluar carcinoma underwent LT in June 2005. LT was performed orthotopically using the clockwise 90° rotation technique with all vessels end-to-end anastomized. The post-operation complications were actively managed and the patient was followed up. Results： Post-operatively, the patient recovered well without major complications,except for a bile duct anastomotic stenosis during the 5^th post-operative month, which was dealt with endoscopic retrograde biliary drainage and percutaneous transhepatic cholangial drainage. Liver function was stable and no tumor recurrence was found during a follow-up period of 30 months. Conclusion： It is feasible to perform LT in patients with CSI. Bile duct anastomotic stenosis is one of the most important complications after LT,which can have a good long-term prognosis if promptly managed.