Chinese Journal of Tissue Engineering Research ›› 2012, Vol. 16 ›› Issue (40): 7596-7600.doi: 10.3969/j.issn.2095-4344.2012.40.032

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Orthotopic liver transplantation for hepatocellular carcinoma and portal vein thrombosis: Refractory bleeding treated with stage Ⅰ vascular anastomosis plus stage Ⅱ biliary-enteric anastomosis

Chen Kai, Zhao Ji, Deng Xiao-fan, Zhang Yu, Yang Hong-ji   

  1. Organ Transplant Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan Province, China
  • Received:2012-01-01 Revised:2012-03-26 Online:2012-09-30 Published:2012-09-30
  • Contact: Yang Hong-ji, Master’s supervisor, Chief physician, Organ Transplant Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan Province, China hongji-yang65@126.com
  • About author:Chen Kai★, Studying for master’s degree, Attending physician, Organ Transplant Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan Province, China ckai0827@163.com

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Abstract:

BACKGROUND: Refractory bleeding often occurred in orthotopic liver transplantation, with difficultly treatment and high operation failure rate, but its effective means for the treatment was not yet reported today.
OBJECTIVE: To investigate the effectiveness of surgical approach with stage Ⅰ vascular anastomosis and gauze packing hemostasis for the treatment of refractory bleeding in orthotopic liver transplantation for hepatocellular carcinoma and portal vein thrombosis, and the feasibility of plus stage Ⅱ biliary-enteric anastomosis completed orthotopic liver transplantation in stage.
METHODS: One patient with refractory bleeding in orthotopic liver transplantation for hepatocellular carcinoma and portal vein thrombosis was treated with stage Ⅰ vascular anastomosis, gauze packing hemostasis and stage Ⅱ biliary-enteric anastomosis. In this study, we observed the effectivity of this hemostasis and recovery after liver transplantation.
RESULTS AND CONCLUSION: In this study, the bleeding was stopped at 2 days after treated with stage Ⅰ vascular anastomosis and gauze packing hemostasis, and the liver function and coagulation function were improved significantly; acute rejection after stage Ⅱ biliary-enteric anastomosis was not obvious, and liver function and coagulation function were improved significantly at 3 days after transplantation. Ultrasonography of the portal vein showed that the lumen of the main portal vein and its branches open and perfusion well. Hepatorenal syndromes such as oliguria, massive ascites and impaired renal function happened at 2 weeks after transplantation. And the hepatorenal syndromes were then gradually restored after treated with Terlipressin. Upper gastrointestinal bleeding caused by stress ulcer was appeared at 2 weeks after transplantation, and cured by the mediccal hemostatic treatment. The patient was discharged at 34 days after treatment. The results of this study show that stage Ⅰ vascular anastomosis and gauze hemostasis hemostasis are effectiveness for the treatment of refractory
bleeding in orthotopic liver transplantation for hepatocellular carcinoma and portal vein thrombosis, and plus stage Ⅱ biliary-enteric anastomosis is entirely feasible to complete orthotopic liver transplantation in stage.

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