Self-Expanding metal stent placement for hepatic venous outflow obstruction following ex vivo liver resection and autotransplantation.

IF 1.8 3区医学 Q2 SURGERY

Langenbeck's Archives of Surgery Pub Date : 2025-09-30 DOI:10.1007/s00423-025-03801-w

Xinyu You, Bangyou Zuo, Chong Yang, Tao Liu, Donghui Cheng, Jiangji Peng, Peng Li, Jianjie Hao, Yu Zhang

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引用次数: 0

Abstract

Objective: To evaluate the safety and efficacy of self-expanding metal stents (SEMS) for managing hepatic venous outflow obstruction (HVOO) following ex vivo liver resection and autotransplantation (ELRA).

Methods: We retrospectively analyzed patients who received SEMS placement for HVOO after ELRA between January 2018 and December 2024. The study analyzed details of vascular invasion, liver resection, vascular reconstruction during ELRA, and the condition before and after stent placement. Complications and short-term and long-term prognoses were also observed.

Results: The study included 10 patients who underwent SEMS placement for HVOO after ELRA. Three patients had preoperative stent placement for Budd-Chiari syndrome. During ELRA, 3 patients underwent left trisegmentectomy, and 7 underwent right trisegmentectomy. Six patients required artificial vascular grafts for inferior vena cava (IVC) reconstruction, and 4 patients underwent partial IVC resection with bovine pericardial patch reconstruction. All patients underwent HV-IVC end-to-side anastomosis after HV widening. Two cases used allogeneic vein reconstruction for hepatic venous outflow. The median time to HVOO after ELRA was 3.0 [IQR 2.0-7.3] months. Three patients experienced left hepatic vein (LHV) obstruction, and 7 experienced right hepatic vein (RHV) obstruction, with a median hepatic venous pressure gradient (HVPG) of 11.8 [IQR 8.8-14.1] mmHg. After stent placement, the HVPG decreased to a median of 2.8 [IQR 2.1-3.1] mmHg. The median follow-up period was 29.5 [IQR 11.3-55.8] months. During follow-up, one patient developed restenosis; other than this, no complications of grade III or higher occurred.

Conclusion: In this single-center cohort, SEMS demonstrated favorable safety and efficacy for HVOO after ELRA, However, larger multicenter studies are required to validate these findings and assess long-term outcomes.

查看原文本刊更多论文

体外肝切除和自体肝移植术后肝静脉流出梗阻的自膨胀金属支架置入。

目的：评价自体扩张金属支架（SEMS）治疗离体肝切除自体移植（ELRA）术后肝静脉流出梗阻（HVOO）的安全性和有效性。方法：回顾性分析2018年1月至2024年12月期间接受SEMS安置的ELRA术后HVOO患者。本研究分析了ELRA期间血管侵犯、肝脏切除、血管重建的细节，以及支架置入前后的情况。观察并发症及近期和长期预后。结果：本研究纳入了10例ELRA术后HVOO的SEMS安置患者。3例患者术前行Budd-Chiari综合征支架置入术。在ELRA期间，3例患者行左三节切除术，7例患者行右三节切除术。6例患者行下腔静脉（IVC）人工血管移植重建，4例患者行部分下腔静脉切除术和牛心包补片重建。所有患者在HV扩阔后均行HV- ivc端侧吻合。异体静脉重建肝静脉流出2例。ELRA术后至HVOO的中位时间为3.0 [IQR 2.0-7.3]个月。左肝静脉（LHV）梗阻3例，右肝静脉（RHV）梗阻7例，中位肝静脉压梯度（HVPG）为11.8 [IQR 8.8-14.1] mmHg。支架置入后，HVPG中位数降至2.8 [IQR 2.1-3.1] mmHg。中位随访时间为29.5个月[IQR 11.3-55.8]个月。随访期间，1例患者发生再狭窄；除此之外，未发生III级及以上并发症。结论：在这个单中心队列中，SEMS显示了ELRA后HVOO的良好安全性和有效性，然而，需要更大的多中心研究来验证这些发现并评估长期结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Langenbeck's Archives of Surgery 医学-外科

CiteScore

3.30

自引率

8.70%

发文量

342

审稿时长

4-8 weeks

期刊介绍： Langenbeck''s Archives of Surgery aims to publish the best results in the field of clinical surgery and basic surgical research. The main focus is on providing the highest level of clinical research and clinically relevant basic research. The journal, published exclusively in English, will provide an international discussion forum for the controlled results of clinical surgery. The majority of published contributions will be original articles reporting on clinical data from general and visceral surgery, while endocrine surgery will also be covered. Papers on basic surgical principles from the fields of traumatology, vascular and thoracic surgery are also welcome. Evidence-based medicine is an important criterion for the acceptance of papers.