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상간하대정맥부터 총장골정맥분지까지 연장된 하대정맥 평활근 육종의 체외절제 후 인공 하대정맥 재건 및 자가 간이식
문덕복(Deok-Bog Moon),이승규(Sung-Kyu Lee),김기훈(Ki-Hum Kim),안철수(Chul-Soo Ahn),하태용(Tae-Yong Ha),송기원(Gi-Won Song),정동환(Dong-Hwan Jung),유제호(Je-Ho Ryu),김관우(Kwan-Woo Kim),고경훈(Kyoung-Hoon Ko),최남규(Nam-Kyu Choi) 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.3
Ex situ resection and hepatic auto-transplantation as devised by Pichlmayr may be an answer for a lesion that has close proximity to or has invade the major hepatic veins. We report here on a 31-year-old female patient with a leiomyosarcoma extending from the suprahepatic vena cava to the bifurcation of the common iliac vein, and this tumor was deemed not accessible by the conventional in situ surgical techniques. The liver and retrohepatic inferior vena cava was removed en bloc and taken to the back-table where the neoplasm invading the cava wall was removed together with the inferior vena cava. The inferior vena cava was then replaced by a 26- mm Dacron graft proximally and a 20-mm ringed polytetrafluoroethylene (PTFE) graft distally, and the outflows of the liver was reconstructed to a single opening with using longitudinallyopened autogenous great saphenous vein fencing. The liver was then autotransplanted by the Piggyback technique. Both renal veins were not reconstructed because both gonadal veins were preserved during the operation. The postoperative course was uneventful and the patient is in good health until now.
Shin Hwang(황신),Sung-Gyu Lee(이승규),Dong-Hwan Jung(정동환),Ki-Hum Kim(김기훈),Tae-Yong Ha(하태용),Gi-Won Song(송기원) 한국간담췌외과학회 2009 한국간담췌외과학회지 Vol.13 No.1
Hepatitis B virus (HBV)-induced FHF fulminant hepatic failure (FHF) has been a main indication for urgent liver transplantation (LT), and these patients with hepatitis B virus (HBV)-induced FHF have a UNOS status of I. However, HBV-associated FHF has been downgraded to status IIa since late 2007 to eliminate the possibility of confusion between FHF and subacute / acute-orchronic liver failure. This current study evaluated the influence of this change of the UNOS status on organ allocation by using 4 sets of data (a single-institution study without LT cases, a singleinstitution study that included LT cases, a single-institution LT study and the nation-wide LT data). During the 12-year experience at Severance Hospital, HBV infection made up 30% of the 60 FHF patients. For the FHF patients, only 28.3% survived without LT. During the 6-year experience at Asan Medical Center, HBV infection made up 15.8% of the 114 FHF patients. Fifteen percent survived without LT, but 86% survived after LT. Only 1 out of the 14 cases of LT was deceased-donor LT. During the 2-year study on urgent LT at Asan Medical Center, there were 578 LT cases, including 520 living-donor LT and 58 deceased-donor LT. Of them, 120 patients (21.7%) had a UNOS status of I or IIa. The patients with HBV made up 17.8% of the status I patients and 80.3% of the status IIa patients. The one-year patient survival was 83.2% following living-donor LT and this was 71.1% following deceased-donor LT. For the nation-wide data for 8 years, 245 patients were allocated for a deceased-donor liver graft as status I (n=85) or IIa (n=160). Of them, 231 grafts were actually implanted. It was estimated that there is a 2.9- times difference in the probability for organ allocation between UNOS status I and IIa. In conclusion, down-grading of HBV-associated FHF from UNOS status I to status IIa would result in a significantly decreased probability to receive deceased-donor liver grafts. Therefore, it is concluded that such down-grading seems to involve unreasonable discrimination, leading to a disadvantage for patients with HBV-associated FHF. To avoid such dilemma for deceased organ allocation, Korea should consider adopting the model for end-stage liver disease (MELD).