Application of autologous portal vein graft in the in vitro hepatectomy and liver autotransplantation

Abstract

Objective To explore the application of autologous portal vein graft in the in vitro hepatectomy and liver autotransplantation. Methods Clinical data of a patient with cholangiocarcinoma who underwent in vitro hepatectomy and liver autotransplantation in the Southwest Hospital of the Third Military Medical University on July 2009 were analyzed retrospectively. The patient was male, 61 years old and was admitted in the hospital for one month of upper abdominal pain and discomfort, hypodynamia, loss of appetite, yellow skin and sclera for half a month and 6 days of shallowing stool color. Occupying lesions in the left medial lobe and right anterior lobe, infiltrated middle, left hepatic vein and infiltrated root of the right hepatic vein were observed by computed tomography(CT). The magnetic resonance cholangiopancreatography(MRCP) showed the left hepatic duct was infiltrated and intrahepatic bile duct dialated. The informed consent of the patient was obtained and the ethical committee approval was received. The patient received in vitro hepatectomy and liver autotransplantation. The liver was removed out of the body and the tumor was resected completely. The branch of the right hepatic vein on the cut of liver underwent plasty to be a jointly entry. The liver venous outflow was rebuilt using autologous portal vein graft and the remanent liver was transplanted in situ. The intraoperative and postoperative condition of the patient were observed. Results The operation was successful. The anhepatic phase was 200 min. The time spend of in vitro hepatectomy and reconstruction of venous outflow using autologous portal vein graft was 130 min The patient recovered well and the liver function indexes regained normal 15 d after the operation. The blood flow of the hepatic vein, portal vein and hepatic artery were good by repeated CT scan. The patient were discharged healthy. The postoperative pathological examination showed cholangiocarcinoma. Conclusions For the in vitro hepatectomy and liver autotransplantation, there are advantages of using the autologous portal vein graft to rebulid the liver venous outflow. To select a suitable patient can achieve good clinical efficacy. Key words: Portal vein; Hepatectomy; Liver transplantation; Liver neoplasms