取自受者颈外静脉的血管移植物在肝母细胞瘤患儿肝移植中形成门静脉-门静脉吻合：单中心经验

摘要(中文译文)

我们研究了一例肝母细胞瘤侵犯门静脉血管并伴门静脉广泛血栓形成、无法行肿瘤切除、最终接受肝移植治疗的病例。对一名诊断为胎儿上皮型肝母细胞瘤、无转移征象的5岁男童（15 kg）进行检查，显示甲胎蛋白水平为22684 IU/mL，经联合化疗后降至16 IU/mL。腹部超声显示右肝叶占位性病变、门静脉海绵样变性、肝脾肿大及肝脏弥漫性局灶性改变。腹部计算机断层扫描显示肝脏占位性病变并侵犯下腔静脉、门静脉海绵样变性、肝脾肿大及肝内外胆管扩张。患儿接受了来自活体亲属供体的2段和3段肝移植。受者术中发现门静脉广泛血栓形成，遂行血栓切除术。为完成门静脉吻合，从受者左侧颈外静脉取长约3 cm的静脉移植物。由于受者门静脉多发血管变形，无法将供肝门静脉与受者自体门静脉直接吻合，故将供肝门静脉与受者肠系膜上静脉及颈外静脉移植物之间进行吻合。术后早期，在移植肝功能良好的背景下，观察到肝转氨酶、胆红素及甲胎蛋白下降。多普勒超声显示血流满意。尽管受者门静脉存在明显的血管变形并伴部分血栓形成，使用受者自身颈外静脉的自体血管移植物来构建门-门静脉吻合仍是最佳方案。

Abstract

We investigated hepatoblastoma with invasion into the vessels of the portal vein and widespread thrombosis of the portal vein, where tumor resection is impossible, that was treated with liver transplant. Examination of 5-year-old boy (15 kg) diagnosed with hepatoblastoma of the liver of fetal epithelial variant without signs of metastasis, showed alpha-fetoprotein level of 22684 IU/mL, which decreased to 16 IU/mL after polychemotherapy. Abdominal ultrasonography showed signs of a space-occupying lesion in the right liver lobe, cavernous transformation of the portal vein, hepatosplenomegaly, and diffuse focal changes in the liver. Abdominal computed tomography showed signs of liver space-occupying lesions and invasion into the inferior vena cava and cavernous transformation of the portal vein, hepatosplenomegaly, and dilatation of intra- and extrahepatic bile ducts. The child received transplant of 2 and 3 liver segments from a living related donor. Extensive thrombosis of the portal vein was detected in the recipient, and thrombectomy was performed. To perform a portal anastomosis, a venous graft from the external jugular vein on the left, 3 cm long, was taken from the recipient. Because a portal anastomosis directly with the native portal vein of the recipient was not possible because of multiple vascular transformation, anastomosis was performed between the portal vein of the donor liver and the superior mesenteric vein of the recipient and graft from the external jugular vein. In the early postoperative period, against the background of satisfactory liver graft function, decreased liver transaminases, bilirubin, and alpha-fetoprotein were noted. Doppler sonography showed satisfactory blood flow. Despite pronounced vascular transformation of the portal vein with partial thrombosis of the portal vein in the recipient, the use of a native vascular graft from the external jugular vein of the recipient himself to form a portoportal anastomosis was an optimal solution.

如何引用

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