臨床外科77巻3号

2022年03月発行

特集 肝胆膵術後合併症—どう防ぐ？ どう対処する？

肝臓外科

肝静脈狭窄

著者： 三原裕一郎¹ 赤松延久¹ 長谷川潔¹

所属機関： ¹東京大学医学部附属病院肝胆膵外科・人工臓器移植外科

ページ範囲：P.276 - P.281

文献概要

【ポイント】
◆肝臓手術での合併症としての肝静脈狭窄による肝静脈血の流出路障害（HVOO）は肝切除術ではきわめて稀だが，生体肝移植ではしばしば経験する合併症である．
◆HVOOはBudd-Chiari症候群様の病態を呈することが多く，短期間で急性肝不全に進展する場合もある．
◆HVOOに対する治療はIVRが基本であるが，術直後に発症するHVOOでは手術による位置補正が有効な場合もある．

参考文献

1）Shimata K, Sugawara Y, Honda M, et al：Efficacy of repeated balloon venoplasty for treatment of hepatic venous outflow obstruction after pediatric living-donor liver transplantation：a single-institution experience. Pediatr Transplant 23：e13522, 2019

2）Balci D, Ozcelik M, Kirimker EO, et al：Extended left hepatectomy for intrahepatic cholangiocarcinoma：hepatic vein reconstruction with in-situ hypothermic perfusion and extracorporeal membrane oxygenation. BMC Surg 18：7, 2018

3）Sequeira FW, Weber TR, Smith WL, et al：Budd-Chiari syndrome caused by hepatic torsion. AJR Am J Roentgenol 137：393-394, 1981

4）Pitre J, Panis Y, Belghiti J：Left hepatic vein kinking after right hepatectomy：a rare cause of acute Budd-Chiari syndrome. Br J Surg 79：798-799, 1992

5）Wang JK, Truty MJ, Donohue JH：Remnant torsion causing Budd-Chiari syndrome after right hepatectomy. J Gastrointest Surg 14：910-912, 2010

6）Ausania F, McDonald S, Kallas K, et al：Intravascular stenting to treat left hepatic vein stenosis following extended right hepatectomy. Abdom Imaging 38：417-418, 2013

7）Sato N, Kenjo A, Tsuchiya T, et al：Remnant left lobe torsion causing hepatic venous outflow obstruction after hepatic right lobectomy for giant hepatocellular carcinoma：report of a case. Fukushima J Med Sci 60：170-174, 2014

8）Ariche A, Klein Y, Cohen A, et al：Major hepatectomy for complex liver trauma. Hepatobiliary Surg Nutr 4：299-302, 2015

9）Benesch M, Urban C, Deutschmann H, et al：Management of Budd-Chiari syndrome by hepatic vein stenting after extended right hepatectomy. J Pediatr Surg 37：1640-1642, 2002

10）Di Domenico S, Rossini A, Petrocelli F, et al：Recurrent acute Budd-Chiari syndrome after right hepatectomy：US color-Doppler vascular pattern and left hepatic vein stenting for treatment. Abdom Imaging 38：320-323, 2013

11）Ninomiya M, Ikeda T：Compressive stenosis of the left hepatic vein as a pathogenesis of postresectional liver failure：a case report. J Med Case Rep 4：163, 2010

12）Lhuaire M, Piardi T, Bruno O, et al：Post-hepatectomy liver failure：should we consider venous outflow? Int J Surg Case Rep 16：154-156, 2015

13）Imai D, Furukawa K, Shiba H, et al：Balloon venoplasty for liver failure due to stenosis of the left hepatic vein after right tri-segmentectomy. Int Surg 98：160-163, 2013

14）Van Ha TG, Tullius TG Jr, Navuluri R, et al：Percutaneous treatment of IVC obstruction due to post-resection hepatic torsion associated with IVC thrombosis. CVIR Endovasc 2：14, 2019

15）Kanno H, Yoshida A, Goto Y, et al：A case of hepatic venous outflow obstruction caused by migration of the remnant liver into the subphrenic space after extended posterior sectionectomy of the liver. Int J Surg Case Rep 76：297-300, 2020

16）Kawaguchi Y, Ishizawa T, Miyata Y, et al：Portal uptake function in veno-occlusive regions evaluated by real-time fluorescent imaging using indocyanine green. J Hepatol 58：247-253, 2013

17）Mise Y, Hasegawa K, Satou S, et al：Venous reconstruction based on virtual liver resection to avoid congestion in the liver remnant. Br J Surg 98：1742-1751, 2011

18）Yamamoto M, Akamatsu N, Hayashi A, et al：Safety and efficacy of venous reconstruction in liver resection using cryopreserved homologous veins. J Hepatobiliary Pancreat Sci 24：511-519, 2017

19）Ito K, Akamatsu N, Togashi J, et al：Outflow reconstruction using cryopreserved homologous venous grafts in living donor liver transplantation. Transplant Proc 49：109-114, 2017

20）Hashimoto T, Sugawara Y, Tamura S, et al：One orifice vein reconstruction in left liver plus caudate lobe grafts. Transplantation 83：225-227, 2007

21）Ito K, Akamatsu N, Tani K, et al：Reconstruction of hepatic venous tributary in right liver living donor liver transplantation：the importance of the inferior right hepatic vein. Liver Transpl 22：410-419, 2016

22）Akamatsu N, Sugawara Y, Kaneko J, et al：Surgical repair for late-onset hepatic venous outflow block after living-donor liver transplantation. Transplantation 77：1768-1770, 2004