联合腹腔镜和介入技术治疗门静脉-腔静脉瘘合并肝脏局灶性结节性增生

Combined laparoscopic and interventional therapy for congenital portosystemic shunt with hepatic focal nodular hyperplasia

目的总结1例先天性门静脉-腔静脉瘘(CPS)合并肝脏局灶性结节性增生(FNH)患者的外科诊治过程,并探讨联合腹腔镜和介入微创技术治疗的可行性和安全性。方法回顾性分析四川大学华西医院于2020年3月收治的1例CPS合并FNH患者的临床病理学资料。结果患者行腹腔镜下肝脏结节切除术+数字减影血管造影技术(DSA)引导下经颈静脉门静脉-腔静脉瘘封堵术。腹腔镜手术部分的手术时间为180 min,术中出血量为50 mL,术后无并发症发生;介入手术部分的手术时间为230 min,术中出血量为10 mL,患者术后恢复顺利,无并发症发生。腹腔镜术后4 d拔除腹腔引流管,术后8 d康复出院。现患者已随访6个月,一般情况良好。结论 CPS患者应在多学科协作组讨论下制定个性化的治疗方案,腹腔镜和介入技术联合可以微创且高效地达到同时解决门静脉-腔静脉分流瘘道及肝脏良性结节的目的。

Objective To summarize the treatment of a patient with congenital portosystemic shunt(CPS)complicated with hepatic focal nodular hyperplasia(FNH), and to explore the feasibility and safety of combined laparoscopy and interventional radiology therapy at the same time. Methods The clinicopathological data of a patient with CPS complicated with hepatic FNH who admitted to West China Hospital of Sichuan University in March 2019 was retrospectively analyzed. Results The patient underwent laparoscopic liver nodule resection and digital subtraction angiography(DSA) guided jugular portal portosystemic shunt fistula embolization. The laparoscopic surgery operation time was 180 min and the intraoperative blood loss was 50 mL, and for interventional procedure was 230 min and 10 mL respectively. There were no complications after operation and the patient was successfully discharged on the 8 th day after surgery. The patient was followed up for six months and in good condition. Conclusions CPS patient should develop individualized treatment under the discussion of multidisciplinary cooperation group. The combination of laparoscopy and interventional technique can be minimally invasive and efficient to solve portal vein-avitary shunt fistula and benign hepatic nodules at the same time.