经腹腔心包路径肝上下腔静脉与右心房吻合肝移植治疗布-加综合征合并肝癌1例附手术视频

叶征辉; 赵红川; 耿小平; 黄帆; 王国斌; 王伟; 余孝俊; 吴若林; 侯刘进; 张兴华; 贺智翔

doi:10.3969/j.issn.1674-7445.2023116

经腹腔心包路径肝上下腔静脉与右心房吻合肝移植治疗布-加综合征合并肝癌1例附手术视频

doi: 10.3969/j.issn.1674-7445.2023116

230022　合肥，安徽医科大学第一附属医院普外科暨器官移植中心

基金项目: 安徽省临床医学研究转化专项（202204295107020015）

详细信息

作者简介:

通讯作者:
赵红川（ORCID：0009-0008-2266-6352），博士，主任医师，研究方向为器官移植，Email：zhc0117@sina.com

中图分类号: R617， R735.7
计量
- 文章访问数: 295
- HTML全文浏览量: 205
- PDF下载量: 32
- 被引次数: 0
出版历程
- 收稿日期: 2023-06-11
- 网络出版日期: 2023-08-25
- 刊出日期: 2023-11-09

Transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium in liver transplantation for Budd-Chiari syndrome complicated with liver cancer: a case report with surgical video

General Surgery and Organ Transplantation Center, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China

More Information

Corresponding author: Zhao Hongchuan, Email: zhc0117@sina.com

摘要

摘要: 目的总结经腹腔心包路径供肝肝上下腔静脉与受者右心房吻合肝移植治疗布-加综合征（BCS）合并肝癌的相关经验。方法回顾性分析1例经腹腔心包路径肝上下腔静脉与右心房吻合肝移植治疗BCS合并肝癌病例的临床资料。结果患者的肝静脉和肝上下腔静脉局部闭塞，在心脏不停跳情况下，采用经腹腔心包路径完成肝上下腔静脉与右心房吻合肝移植，此外，由于受者肝动脉病变，采用受者脾动脉切断，远端结扎，近端反转与供肝肝总动脉吻合，完成肝动脉重建，手术过程顺利。术后1周左右移植肝肝功能逐步恢复正常，无重大并发症发生。患者术后25 d出院，随访8个月余无BCS复发征象。结论经腹腔心包路径肝上下腔静脉与右心房吻合肝移植治疗BCS是安全可行的，对于合并肝癌的患者预后较好。
- 布-加综合征 /
- 肝移植 /
- 肝癌 /
- 经腹腔心包路径 /
- 肝上下腔静脉 /
- 右心房 /
- 肝动脉重建 /
- 肝硬化
Abstract: Objective To summarize clinical experience of transabdominal pericardial anastomosis of suprahepatic vena cava of the donor and right atrium of the recipient in liver transplantation for Budd-Chiari syndrome (BCS) complicated with liver cancer. Methods Clinical data of a BCS patient complicated with liver cancer undergoing transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium in liver transplantation were retrospectively analyzed. Results The hepatic vein and suprahepatic vena cava were partially occluded in the patient. Liver transplantation was completed by transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium with beating-heart. In addition, due to pathological changes of the recipient's hepatic artery, splenic artery of the recipient was cut off, distal ligation was performed, and the proximal end was reversed and anastomosed with the common hepatic artery of the donor liver, and the reconstruction of hepatic artery was completed. The surgery was successfully performed. At approximately postoperative 1 week, the function of the liver allograft was gradually restored to normal, and no major complications occurred. The patient was discharged at postoperative 25 d. No signs of BCS recurrence was reported after 8-month follow-up. Conclusions It is safe and feasible to treat BCS by liver transplantation with transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium. BCS patients complicated with liver cancer obtain favorable prognosis.
- Budd-Chiari syndrome /
- Liver transplantation /
- Liver cancer /
- Transabdominal pericardial pathway /
- Suprahepatic vena cava /
- Right atrium /
- Hepatic artery reconstruction /
- Cirrhosis

HTML全文

图 1 1例BCS患者术前影像学、手术吻合情况及病理学检查结果

注：A、B图示肝静脉和肝上下腔静脉狭窄，肝右叶肿瘤伴门静脉右支分支癌栓可能（红色箭头所示）；C、D图示供肝肝上下腔静脉与受者右心房吻合；E、F图示移植肝恢复血流后的外观及吻合完成的肝动脉、门静脉；G图示切除病肝的外观；H图示病肝病理学检查可见中-低分化肝细胞性肝癌伴出血、坏死（苏木素-伊红染色，×100）。

Figure 1. Preoperative imaging, surgical anastomosis and pathological examination results of one BCS patient

下载: 全尺寸图片幻灯片

下载: 全尺寸图片幻灯片

参考文献(35)

[1]	WIEST I, TEUFEL A, EBERT MP, et al. Budd-Chiari syndrome, review and illustration[J]. Z Gastroenterol, 2022, 60(9): 1335-1345. DOI: 10.1055/a-1645-2760.
[2]	LUPASCO I, DUMBRAVA VT. Diagnosis and therapy of Budd Chiari syndrome[J]. Med Pharm Rep, 2021, 94(Suppl No 1): S68-S71.
[3]	陈宏亮, 张庆桥, 徐浩, 等. JAK2V617F基因突变与非突变布-加综合征患者临床特征的对比[J]. 中华肝脏病杂志, 2022, 30(12): 1365-1369. DOI: 10.3760/cma.j.cn501113-20210901-00443. CHEN HL, ZHANG QQ, XU H, et al. Comparison of clinical features of JAK2V617F gene mutation and non-mutation in patients with Budd-Chiari syndrome[J]. Chin J Hepatol, 2022, 30(12): 1365-1369. DOI: 10.3760/cma.j.cn501113-20210901-00443.
[4]	王雪莹, 许文涛. 《2021年亚太肝病学会共识指导: 布-加综合征》摘译[J]. 临床肝胆病杂志, 2021, 37(11): 2555-2557. DOI: 10.3969/j.issn.1001-5256.2021.11.014. WANG XY, XU WT. An excerpt of Budd-Chiari syndrome: consensus guidance of the Asian Pacific Association for the Study of the Liver (APASL) [J]. J Clin Hepatol, 2021, 37(11): 2555-2557. DOI: 10.3969/j.issn.1001-5256.2021.11.014.
[5]	中华医学会放射学分会介入学组. 布加综合征介入诊疗规范的专家共识[J]. 中华放射学杂志, 2010, 44(4): 345-349. DOI: 10.3760/cma.j.issn.1005-1201.2010.04.003. Interventional Group, Branch of Radiology of Chinese Medical Association. Guidelines of the interventional treatment for Budd-Chiari syndrome[J]. Chin J Radiol, 2010, 44(4): 345-349. DOI: 10.3760/cma.j.issn.1005-1201.2010.04.003.
[6]	中国医师协会腔内血管学专业委员会腔静脉阻塞专家委员会. 布-加综合征亚型分型的专家共识[J]. 临床肝胆病杂志, 2017, 33(7): 1229-1235. DOI: 10.3969/j.issn.1001-5256.2017.07.005. Venae cavae Obstruction Expert Committee of Endovascular Angiology Professional Committee of Chinese Medical Doctor Association. Expert consensus on the classification of subtype in Budd-Chiari syndrome[J]. J Clin Hepatol, 2017, 33(7): 1229-1235. DOI: 10.3969/j.issn.1001-5256.2017.07.005.
[7]	XIA FF, NI CF, ZU MH. Percutaneous recanalization in hepatic vein-type Budd-Chiari syndrome: hepatic or accessory hepatic vein[J]. Minim Invasive Ther Allied Technol, 2023, 32(1): 18-23. DOI: 10.1080/13645706.2022.2145568.
[8]	赵晨, 张庆桥, 徐浩, 等. 采用Viabahn支架行经颈静脉肝内门体分流术治疗肝静脉广泛闭塞布加综合征的疗效分析[J]. 中华肝脏病杂志, 2021, 29(10): 972-976. DOI: 10.3760/cma.j.cn501113-20200331-00151. ZHAO C, ZHANG QQ, XU H, et al. Analysis of curative efficacy of transjugular intrahepatic portosystemic shunt using viabahn stent in the treatment of Budd-Chiari syndrome with extensive hepatic vein occlusion[J]. Chin J Hepatol, 2021, 29(10): 972-976. DOI: 10.3760/cma.j.cn501113-20200331-00151.
[9]	AKTAS H, OZER A, YILMAZ TU, et al. Liver transplantation for Budd-Chiari syndrome: a challenging but handable procedure[J]. Asian J Surg, 2022, 45(7): 1396-1402. DOI: 10.1016/j.asjsur.2021.09.007.
[10]	TALAIE R, JALAEIAN H, ROSTAMBEIGI N, et al. Recanalization and reconstruction of a chronically occluded inferior vena cava through an existing transjugular intrahepatic portosystemic shunt in the setting of Budd-Chiari syndrome[J]. Vasc Endovascular Surg, 2021, 55(5): 529-533. DOI: 10.1177/15385744211002026.
[11]	IBACH M, EURICH D, DOBRINDT E, et al. Orthotopic liver transplantation for Budd-Chiari syndrome: observations from a 30-year liver transplant program[J]. Medicina (Kaunas), 2021, 57(8): 821. DOI: 10.3390/medicina57080821.
[12]	GARMPIS N, DAMASKOS C, PREVEZANOS D, et al. Liver transplantation and Budd-Chiari syndrome: when the cause becomes the solution[J]. Maedica (Bucur), 2022, 17(2): 415-419. DOI: 10.26574/maedica.2022.17.2.415.
[13]	ALUKAL JJ, ZHANG T, THULUVATH PJ. Outcomes of status 1 liver transplantation for Budd-Chiari syndrome with fulminant hepatic failure[J]. Am J Transplant, 2021, 21(6): 2211-2219. DOI: 10.1111/ajt.16410.
[14]	叶啟发, 明英姿, 宫念樵, 等. 腔静脉-心房吻合肝移植治疗布加综合征的临床疗效[J]. 中华消化外科杂志, 2019, 18(4): 342-346. DOI: 10.3760/cma.j.issn.1673-9752.2019.04.009. YE QF, MING YZ, GONG NQ, et al. Clinical effect of venae cavae atrial anastomosis in liver transplantation for Budd-Chiari syndrome[J]. Chin J Dig Surg, 2019, 18(4): 342-346. DOI: 10.3760/cma.j.issn.1673-9752.2019.04.009.
[15]	HONG SY, KIM BW, WANG HJ, et al. Hanging hepato-atrial anastomosis in deceased-donor liver transplantation for Budd-Chiari syndrome with extensive vena cava obliteration: a case report[J]. Transplant Proc, 2017, 49(10): 2395-2398. DOI: 10.1016/j.transproceed.2017.09.018.
[16]	SABRA TA, OKAJIMA H, TAJIMA T, et al. Living donor liver transplantation for adult Budd Chiari syndrome - resection without replacement of retrohepatic IVC: a case report[J]. Int J Surg Case Rep, 2018, 42: 50-54. DOI: 10.1016/j.ijscr.2017.11.050.
[17]	YOON YI, LEE SG, MOON DB, et al. Surgical techniques and long-term outcomes of living-donor liver transplantation with inferior vena cava replacement using atriocaval synthetic interposition graft for Budd-Chiari syndrome[J]. Ann Surg, 2019, 269(4): e43-e45. DOI: 10.1097/SLA.0000000000002847.
[18]	叶征辉, 赵红川, 耿小平, 等. 同种异体原位肝移植的复杂肝动脉重建经验总结[J]. 器官移植, 2019, 10(5): 589-593, 611. DOI: 10.3969/j.issn.1674-7445.2019.05.020. YE ZH, ZHAO HC, GENG XP, et al. Experience summary of complex hepatic artery reconstruction in orthotopic liver transplantation[J]. Organ Transplant, 2019, 10(5): 589-593, 611. DOI: 10.3969/j.issn.1674-7445.2019.05.020.
[19]	GOUMARD C, BOLESLAWSKI E, BRUSTIA R, et al. Duct-to-duct biliary reconstruction with or without an intraductal removable stent in liver transplantation: the BILIDRAIN-T multicentric randomised trial[J]. JHEP Rep, 2022, 4(10): 100530. DOI: 10.1016/j.jhepr.2022.100530.
[20]	VEST M, CIOBANU C, NYABERA A, et al. Biliary anastomosis using T-tube versus no T-tube for liver transplantation in adults: a review of literature[J]. Cureus, 2022, 14(4): e24253. DOI: 10.7759/cureus.24253.
[21]	MARTININO A, PEREIRA JPS, SPOLETINI G, et al. The use of the T-tube in biliary tract reconstruction during orthotopic liver transplantation: an umbrella review[J]. Transplant Rev (Orlando), 2022, 36(4): 100711. DOI: 10.1016/j.trre.2022.100711.
[22]	SONG S, LU T, YANG W, et al. T-tube or no T-tube for biliary tract reconstruction in orthotopic liver transplantation: an updated systematic review and meta-analysis[J]. Expert Rev Gastroenterol Hepatol, 2021, 15(10): 1201-1213. DOI: 10.1080/17474124.2021.1903874.
[23]	刘大群,孙晓东,邱伟,等. 影响肝移植术后胆管吻合口狭窄的相关因素分析 [J]. 中华消化外科杂志, 2022, 21(2): 249-255. DOI: 10.3760/cma.j.cn115610-20211129-00602. LIU DQ, SUN XD, QIU W, et al. Analysis of influencing factors for anastomotic biliary stricture after liver transplantation[J]. Chin J Dig Surg, 2022, 21(2): 249-255. DOI: 10.3760/cma.j.cn115610-20211129-00602.
[24]	LI Y, DE STEFANO V, LI H, et al. Epidemiology of Budd-Chiari syndrome: a systematic review and meta-analysis[J]. Clin Res Hepatol Gastroenterol, 2019, 43(4): 468-474. DOI: 10.1016/j.clinre.2018.10.014.
[25]	SUN X, QIN T, ZHANG J, et al. The outcomes of interventional treatment for Budd-Chiari syndrome complicated by inferior vena cava thrombosis: systematic review and meta-analysis[J]. Gastroenterol Hepatol, 2021, 44(6): 405-417. DOI: 10.1016/j.gastrohep.2020.06.028.
[26]	邓玉婷, 周俊英. 布加综合征诊治研究进展[J]. 实用肝脏病杂志, 2023, 26(2): 156-159. DENG YT, ZHOU JY. Budd-Chiari syndrome: current state of the art [J]. J Pract Hepatol, 2023, 26(2): 156-159.
[27]	杨红, 宋宇虎, 汪志军. 3种类型布-加综合征的临床特点分析[J]. 临床消化病杂志, 2021, 33(1): 41-45. DOI: 10.3870/lcxh.j.issn.1005-541X.2021.01.09. YANG H , SONG YH, WANG ZJ. To investigate the clinical characteristics of patients with different Budd-Chiari syndrome subtypes[J]. Chin J Clin Gastroenterol, 2021, 33(1): 41-45. DOI: 10.3870/lcxh.j.issn.1005-541X.2021.01.09.
[28]	BAYRAKTAR UD, SEREN S, BAYRAKTAR Y. Hepatic venous outflow obstruction: three similar syndromes[J]. World J Gastroenterol, 2007, 13(13): 1912-1927. DOI: 10.3748/wjg.v13.i13.1912.
[29]	ALUKAL JJ, ZHANG T, THULUVATH PJ. A nationwide analysis of Budd-Chiari syndrome in the United States[J]. J Clin Exp Hepatol, 2021, 11(2): 181-187. DOI: 10.1016/j.jceh.2020.08.005.
[30]	LIU SY, LI LH, LIU ZC, et al. Development of a prognostic scoring system for hepatic vena cava Budd-Chiari syndrome with hepatocellular carcinoma[J]. Hepatobiliary Pancreat Dis Int, 2023,DOI: 10.1016/j.hbpd.2023.03.005[Epub ahead of print
[31]	KIM CH, CHOI GH, NA HY, et al. Hepatocellular carcinoma with Budd-Chiari syndrome due to membranous obstruction of the inferior vena cava with long-term follow-up: a case report[J]. J Liver Cancer, 2022, 22(2): 194-201. DOI: 10.17998/jlc.2022.08.24.
[32]	LI KS, GUO S, CHEN YX, et al. Budd-Chiari syndrome and its associated hepatocellular carcinoma: clinical risk factors and potential immunotherapeutic benefit analysis[J]. Front Oncol, 2022, 12: 1075685. DOI: 10.3389/fonc.2022.1075685.
[33]	刘召波, 栗光明. 肝移植术后肝癌复发防治进展[J]. 临床肝胆病杂志, 2021, 37(2): 267-271. DOI: 10.3969/j.issn.1001-5256.2021.02.006. LIU ZB, LI GM. Advances in the prevention and treatment of hepatocellular carcinoma recurrence after liver transplantation[J]. J Clin Hepatol, 2021, 37(2): 267-271. DOI: 10.3969/j.issn.1001-5256.2021.02.006.
[34]	郭亚荣, 徐钧, 张和钊, 等. 肝癌肝移植热点问题探讨[J]. 中华消化外科杂志, 2023, 22(2): 209-213. DOI: 10.3760/cma.j.cn115610-20230118-00025. GUO YR, XU J, ZHANG HZ, et al. Discussion on hot issues in liver transplantation for hepatocellular carcinoma[J]. Chin J Dig Surg, 2023, 22(2): 209-213. DOI: 10.3760/cma.j.cn115610-20230118-00025.
[35]	QIN S, REN Z, FENG YH, et al. Atezolizumab plus bevacizumab versus sorafenib in the chinese subpopulation with unresectable hepatocellular carcinoma: phase 3 randomized, open-label IMbrave150 Study[J]. Liver Cancer, 2021, 10(4): 296-308. DOI: 10.1159/000513486.