transplantologiyaТрансплантологияTransplantologiya. The Russian Journal of Transplantation2074-05062542-0909IPO Association of Transplantologists10.23873/2074-0506-2022-14-2-159-173transplantologiya-654Research ArticleКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCASE REPORTSРоль портокавальных шунтов в развитии осложнений после трансплантации печениRole of portocaval shunts in development of complications after liver transplantationЦойД. Л.TsoyD. L.

Дмитрий Львович Цой, врач отделения абдоминальной онкологии и хирургии; ассистент кафедры хирургии, колопроктологии и эндоскопии

620102, Екатеринбург, Волгоградская ул., д. 185620028, Екатеринбург, ул. Репина, д. 3

Dmitriy L. Tsoy, Physician of the Department of Abdominal Oncology and Surgery; Medical Assistant at the Department of Surgery, Coloproctology and Endoscopy

3 Repin St., Ekaterinburg 620028185 Volgogradskaya St., Ekaterinburg 620102

tsoy.transpl@gmail.comhttps://orcid.org/0000-0003-2512-2760ПрудковМ. И.PrudkovM. I.

Михаил Иосифович Прудков, проф., д-р мед. наук, научный руководитель хирургической клиники; заведующий кафедрой хирургии, колопрокологии и эндоскопии

620102, Екатеринбург, Волгоградская ул., д. 185620028, Екатеринбург, ул. Репина, д. 3

Mikhail I. Prudkov, Prof., Dr. Sci. (Med.), Science Director of the Surgical Clinic; Head of the Department of Surgery, Coloprocology, and Endoscopy

3 Repin St., Ekaterinburg 620028185 Volgogradskaya St., Ekaterinburg 620102

ОрловО. Г.OrlovO. G.

Олег Григорьевич Орлов, канд. мед. наук, заведующий отделением абдоминальной онкологии и хирургии

620102, Екатеринбург, Волгоградская ул., д. 185

Oleg G. Orlov, Cand. Sci. (Med.), Head of the Department of Abdominal Oncology and Surgery

3 Repin St., Ekaterinburg 620028

https://orcid.org/0000-0002-4223-3473БессоноваЕ. Н.BessonovaE. N.

Елена Николаевна Бессонова, д-р мед. наук, заведующая отделением гастроэнтерологии; доцент кафедры терапии факультета повышения квалификации и профессиональной переподготовки

620102, Екатеринбург, Волгоградская ул., д. 185620028, Екатеринбург, ул. Репина, д. 3

Elena N. Bessonova, Dr. Sci. (Med.), Head of the Gastroenterology Department; Associate Professor of the Internal Medicine Department, Faculty of the Advanced Training and Professional Retraining

3 Repin St., Ekaterinburg 620028185 Volgogradskaya St., Ekaterinburg 620102

ЛещенкоИ. Г.LeshchenkoI. G.

Илья Геннадьевич Лещенко, заведующий отделением органного донорства

620102, Екатеринбург, Волгоградская ул., д. 185

Ilya G. Leshchenko, Head of the Organ Donation Department

3 Repin St., Ekaterinburg 620028

КардопольцевЛ. В.KardopoltsevL. V.

Лев Владимирович Кардопольцев, заведующий отделением рентгенохирургических методов диагностики и лечения

620102, Екатеринбург, Волгоградская ул., д. 185

Lev V. Kardopoltsev, Head of the Department for X-ray Surgical Methods of Diagnosis and Treatment

3 Repin St., Ekaterinburg 620028

АгеевА. Н.AgeevA. N.

Артем Никифорович Агеев, канд. мед. наук, врач отделения лучевой диагностики

620102, Екатеринбург, Волгоградская ул., д. 185

Artem N. Ageev, Cand. Sci. (Med.), Physician of the Diagnostic Radiology Department

3 Repin St., Ekaterinburg 620028

СолодушкинС. И.SolodushkinS. I.

Святослав Игоревич Солодушкин, канд. физ.-мат. наук, доцент кафедры вычислительной математики и компьютерных наук

620002, Екатеринбург, ул. Мира, д. 19

Svyatoslav I. Solodushkin, Cand. Sci. (Phys.-Math.), Associate Professor of the Computational Mathematics and Computer Science Department

19 Mira St., 620002 Ekaterinburg

ГАУЗ СО «Свердловская областная клиническая больница № 1»; ФГБОУ ВО «Уральский государственный медицинский университет» МЗ РФРоссияSverdlovsk Regional Clinical Hospital No. 1; Ural State Medical UniversityRussian FederationГАУЗ СО «Свердловская областная клиническая больница № 1»РоссияSverdlovsk Regional Clinical Hospital No. 1Russian FederationФГБОУ ВО «Уральский федеральный университет»РоссияUral Federal UniversityRussian Federation202214062022142159173Copyright © Цой Д.Л., Прудков М.И., Орлов О.Г., Бессонова Е.Н., Лещенко И.Г., Кардопольцев Л.В., Агеев А.Н., Солодушкин С.И., 20222022Цой Д.Л., Прудков М.И., Орлов О.Г., Бессонова Е.Н., Лещенко И.Г., Кардопольцев Л.В., Агеев А.Н., Солодушкин С.И.Tsoy D.L., Prudkov M.I., Orlov O.G., Bessonova E.N., Leshchenko I.G., Kardopoltsev L.V., Ageev A.N., Solodushkin S.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jtransplantologiya.ru/jour/article/view/654Актуальность

Актуальность. Портальный кровоток имеет ключевое значение в жизнеспособности трансплантата печени. Портокавальные шунты, образованные на фоне цирроза печени до трансплантации, могут стать причиной синдрома обкрадывания воротной вены, с последующим развитием ишемического некроза трансплантата. На сегодняшний день недостаточно разработана тактика лечения пациентов с синдромом обкрадывания воротной вены при трансплантации печени.

В данной работе наряду с анализом литературы представлен и собственный опыт, накопленный по столь важному, и в то же время малоизученному вопросу.

Цель

Цель. Изучить роль портокавальных шунтов в развитии осложнений после трансплантации печени на основе ретроспективного анализа клинических наблюдений.

Выводы

Выводы. При трансплантации печени портокавальные шунты могут стать причиной развития синдрома обкрадывания воротной вены с последующим развитием печеночной недостаточности. Для диагностики синдрома обкрадывания воротной вены важно использовать данные, полученные на всех этапах трансплантации печени. Хирургическая коррекция синдрома обкрадывания воротной вены может проводиться во время трансплантации печени и в раннем послеоперационном периоде.

Rationale

Rationale. Portal blood flow is a key component in the viability of the liver transplant.

Portocaval shunts formed on the background of the liver cirrhosis before transplantation can cause portal vein steal syndrome, with subsequent development of ischemic necrosis of the graft.

To date, the tactics of treating patients with portal vein steal syndrome during liver transplantation has not been sufficiently developed.

This paper presents a literature review and our own experience on this important, but little-studied issue.

Purpose

Purpose. The purpose of this research is to study the role of portocaval shunts in the development of complications after liver transplantation, based on a retrospective analysis of clinical cases.

Conclusions

Conclusions. In liver transplantation, portocaval shunts can cause the development of portal vein steal syndrome with subsequent development of liver failure. For the diagnosis of portal vein steal syndrome, it is important to use the data obtained at all stages of liver transplantation. Surgical correction of portal vein steal syndrome can be performed during liver transplantation and in the early postoperative period.

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The authors declare that there are no conflicts of interest present.