超越雷克斯:针对活体肝移植术后晚期肝外门静脉闭塞的创新性肝中门静脉旁路术。

IF 6.1 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Hepatobiliary surgery and nutrition Pub Date : 2024-08-01 Epub Date: 2024-07-05 DOI:10.21037/hbsn-23-616
Chee-Chien Yong, Hsu-Ting Yen, Yu-Fan Cheng, Leona Bettina Dungca, Raymond Joseph De Vera, Itsuko Chih-Yi Chen, Chao-Long Chen
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引用次数: 0

摘要

无论在肝移植范围内还是范围外,中肾分流术(MRB)都是公认的治疗儿童和成人肝外门静脉闭塞(EHPVO)继发性门静脉高压症的有效方法。这是大多数中心首选的手术治疗方法,因为它不仅能解决门静脉高压问题,还能恢复门肝血流的生理性流动。然而,对于某些患者来说,这项技术的标志性部位雷克斯凹可能无法安全进入。我们介绍了一名因新生儿肝炎接受活体肝移植(LDLT)的 22 岁男性患者。移植后 13 年,他因 EHPVO 出现静脉曲张出血。为了解决反复发作的消化道出血问题,我们采用了各种内窥镜、放射学和外科干预措施,但效果并不理想。我们为这位术后广泛粘连、肝周袢和腔隙转化的患者实施了肝中门静脉旁路术(MIPVB),这是 MRB 的创新替代方案。在无法进入雷克斯凹陷的患者中创建 MIPVB 在技术上具有挑战性。但通过多学科团队合作、精心的术前规划和密切的随访,作者证明,对于肝移植术后晚期EHPVO患者来说,这是一种安全可行的选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Beyond the Rex: an innovative meso-intrahepatic portal vein bypass for late-onset extrahepatic portal vein occlusion after living donor liver transplantation.

The Meso-Rex bypass (MRB) is recognized as an effective treatment for portal hypertension secondary to extrahepatic portal vein occlusion (EHPVO) both in the pediatric and adult population, within or outside the context of liver transplantation. It is the preferred surgical treatment in most centers because not only does it addresses the portal hypertension, but also restores physiologic portal hepatopetal flow. However, the Rex recess, the landmark for this technique, may not be safely accessible in some patients. We present a 22-year-old male who underwent living donor liver transplant (LDLT) for neonatal hepatitis. He presented with variceal bleeding due to EHPVO at 13 years after transplant. Various endoscopic, radiologic, and surgical interventions were employed to address the recurrent gastrointestinal bleeding, but results have been unsatisfactory. We performed a meso-intrahepatic portal vein bypass (MIPVB), an innovative alternative to the MRB, for this patient with extensive post-operative adhesions, perihilar collaterals, and cavernous transformation. MIPVB creation in patients where the Rex recess is inaccessible is technically challenging. But with a multidisciplinary team approach, meticulous preoperative planning, and close follow-up, the authors have demonstrated that it is a safe and feasible option for patients with late-onset EHPVO after liver transplantation.

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来源期刊
自引率
10.00%
发文量
392
期刊介绍: Hepatobiliary Surgery and Nutrition (HBSN) is a bi-monthly, open-access, peer-reviewed journal (Print ISSN: 2304-3881; Online ISSN: 2304-389X) since December 2012. The journal focuses on hepatopancreatobiliary disease and nutrition, aiming to present new findings and deliver up-to-date, practical information on diagnosis, prevention, and clinical investigations. Areas of interest cover surgical techniques, clinical and basic research, transplantation, therapies, NASH, NAFLD, targeted drugs, gut microbiota, metabolism, cancer immunity, genomics, and nutrition and dietetics. HBSN serves as a valuable resource for professionals seeking insights into diverse aspects of hepatobiliary surgery and nutrition.
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