Combined laparoscopic and interventional therapy for congenital portosystemicshunt with hepatic focal nodular hyperplasia_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Chang ^1,2 , XIE Kunlin ¹ , LI Xiao ³ , WU Hong ¹ , ZENG Yong ¹ , LU Wusheng ¹ ,  FENG Yuan ³ ,  HUANG Jiwei ¹

1. Department of Liver Surgery/Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
3. Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

FENG Yuan, Email: fynotebook@hotmail.com; HUANG Jiwei, Email: huangjiweimd@hotmail.com

Keywords：

congenital portosystemic shunt; hepatic focal nodular hyperplasia; laparoscopic hepatic resection; interventional radiology therapy; embolization

DOI：

10.7507/1007-9424.202010004

Video：

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Objective To summarize the treatment of a patient with congenital portosystemic shunt (CPS) complicated with hepatic focal nodular hyperplasia (FNH), and to explore the feasibility and safety of combined laparoscopy and interventional radiology therapy at the same time.Methods The clinicopathological data of a patient with CPS complicated with hepatic FNH who admitted to West China Hospital of Sichuan University in March 2019 was retrospectively analyzed.Results The patient underwent laparoscopic liver nodule resection and digital subtraction angiography (DSA) guided jugular portal portosystemic shunt fistula embolization. The laparoscopic surgery operation time was 180 min and the intraoperative blood loss was 50 mL, and for interventional procedure was 230 min and 10 mL respectively. There were no complications after operation and the patient was successfully discharged on the 8th day after surgery. The patient was followed up for six months and in good condition.Conclusions CPS patient should develop individualized treatment under the discussion of multidisciplinary cooperation group. The combination of laparoscopy and interventional technique can be minimally invasive and efficient to solve portal vein-avitary shunt fistula and benign hepatic nodules at the same time.

Citation： LIU Chang, XIE Kunlin, LI Xiao, WU Hong, ZENG Yong, LU Wusheng, FENG Yuan, HUANG Jiwei. Combined laparoscopic and interventional therapy for congenital portosystemicshunt with hepatic focal nodular hyperplasia. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(12): 1556-1560. doi: 10.7507/1007-9424.202010004 Copy

1.	Stringer MD. The clinical anatomy of congenital portosystemic venous shunts. Clin Anat, 2008, 21(2): 147-157.
2.	Lin ZY, Chen SC, Hsieh MY, et al. Incidence and clinical significance of spontaneous intrahepatic portosystemic venous shunts detected by sonography in adults without potential cause. J Clin Ultrasound, 2006, 34(1): 22-26.
3.	Franchi-Abella S, Gonzales E, Ackermann O, et al. Congenital portosystemic shunts: diagnosis and treatment. Abdom Radiol (NY), 2018, 43(8): 2023-2036.
4.	Morgan G, Superina R. Congenital absence of the portal vein: two cases and a proposed classification system for portasystemic vascular anomalies. J Pediatr Surg, 1994, 29(9): 1239-1241.
5.	李震, 汪忠镐, 赵克, 等. Abernethy 畸形致下消化道出血的诊治. 中国普外基础与临床杂志, 2010, 17(1): 83-84.
6.	张翔, 于长鹿, 经翔. 先天性肝内动脉瘤样门静脉-肝静脉瘘一例. 临床放射学杂志, 2008, 27(1): 26-27.
7.	Papamichail M, Pizanias M, Heaton N. Congenital portosystemic venous shunt. Eur J Pediatr, 2018, 177(3): 285-294.
8.	Guérin F, Franchi Abella S, McLin V, et al. Congenital portosystemic shunts: vascular liver diseases: position papers from the francophone network for vascular liver diseases, the French Association for the Study of the Liver (AFEF), and ERN-rare liver. Clin Res Hepatol Gastroenterol, 2020, 44(4): 452-459.
9.	Tang H, Song P, Wang Z, et al. A basic understanding of congenital extrahepatic portosystemic shunt: incidence, mechanism, complications, diagnosis, and treatment. Intractable Rare Dis Res, 2020, 9(2): 64-70.
10.	Pupulim LF, Vullierme MP, Paradis V, et al. Congenital portosystemic shunts associated with liver tumours. Clin Radiol, 2013, 68(7): e362-e369.
11.	Lautz TB, Shah SA, Superina RA. Hepatoblastoma in children with congenital portosystemic shunts. J Pediatr Gastroenterol Nutr, 2016, 62(4): 542-545.
12.	刘建新, 王贤明, 郭少文, 等. 超声诊断先天性肝内门静脉肝静脉瘘 1 例. 中华超声影像学杂志, 2011, 20(5): 435.
13.	Golli M, Kriaa S, Said M, et al. Intrahepatic spontaneous portosystemic venous shunt: value of color and power Doppler sonography. J Clin Ultrasound, 2000, 28(1): 47-50.
14.	Knirsch W, Benz DC, Bühr P, et al. Catheter interventional treatment of congenital portosystemic venous shunts in childhood. Catheter Cardiovasc Interv, 2016, 87(7): 1281-1292.
15.	Bayona Molano MDP, Krauthamer A, Barrera JC, et al. Congenital intrahepatic portosystemic venous shunt embolization: a two-case experience. Clin Case Rep, 2020, 8(4): 761-766.
16.	Allegritti M, Enrico B, Basile E, et al. Non-cirrhotic extra-hepatic porto-systemic shunt causing adult-onset encephalopathy treated with endovascular closure. Dig Dis Sci, 2020, 65(4): 946-951.
17.	Tanoue S, Kiyosue H, Komatsu E, et al. Symptomatic intrahepatic portosystemic venous shunt: embolization with an alternative approach. AJR Am J Roentgenol, 2003, 181(1): 71-78.
18.	Wu L, Zhao L, Lu Y, et al. Interventional embolization of congenital intrahepatic shunts in children. Pediatr Radiol, 2016, 46(4): 541-547.
19.	王玉贤, 张洪新, 李文献, 等. 金属弹簧栓子成功栓塞巨大肝动脉-门静脉瘘 1 例报告. 实用放射学杂志, 2004, 20(2): 120, 123.
20.	Grimaldi C, Monti L, Falappa P, et al. Congenital intrahepatic portohepatic shunt managed by interventional radiologic occlusion: a case report and literature review. J Pediatr Surg, 2012, 47(2): e27-e31.
21.	Suzuki K, Shimohira M, Hashizume T, et al. Dual microcather-dual detachable coil technique in embolization for a congenital intrahepatic portosystemic venous shunt (IPSVS). Minim Invasive Ther Allied Technol, 2013, 22(5): 316-318.
22.	Power AH, Bjarnason H. Large spontaneous intrahepatic portal-systemic venous shunt treated with coil and Amplatzer vascular plug embolization. Perspect Vasc Surg Endovasc Ther, 2012, 24(2): 90-94.
23.	黄顺根. 先天性门体分流诊治进展. 临床外科杂志, 2013, 21(8): 646-649.
24.	Sakamoto S, Kasahara M, Shigeta T, et al. Living donor liver transplantation for multiple intrahepatic portosystemic shunts after involution of infantile hepatic hemangiomas. J Pediatr Surg, 2011, 46(6): 1288-1291.
25.	Sakamoto S, Shigeta T, Fukuda A, et al. The role of liver transplantation for congenital extrahepatic portosystemic shunt. Transplantation, 2012, 93(12): 1282-1287.

1. Stringer MD. The clinical anatomy of congenital portosystemic venous shunts. Clin Anat, 2008, 21(2): 147-157.
2. Lin ZY, Chen SC, Hsieh MY, et al. Incidence and clinical significance of spontaneous intrahepatic portosystemic venous shunts detected by sonography in adults without potential cause. J Clin Ultrasound, 2006, 34(1): 22-26.
3. Franchi-Abella S, Gonzales E, Ackermann O, et al. Congenital portosystemic shunts: diagnosis and treatment. Abdom Radiol (NY), 2018, 43(8): 2023-2036.
4. Morgan G, Superina R. Congenital absence of the portal vein: two cases and a proposed classification system for portasystemic vascular anomalies. J Pediatr Surg, 1994, 29(9): 1239-1241.
5. 李震, 汪忠镐, 赵克, 等. Abernethy 畸形致下消化道出血的诊治. 中国普外基础与临床杂志, 2010, 17(1): 83-84.
6. 张翔, 于长鹿, 经翔. 先天性肝内动脉瘤样门静脉-肝静脉瘘一例. 临床放射学杂志, 2008, 27(1): 26-27.
7. Papamichail M, Pizanias M, Heaton N. Congenital portosystemic venous shunt. Eur J Pediatr, 2018, 177(3): 285-294.
8. Guérin F, Franchi Abella S, McLin V, et al. Congenital portosystemic shunts: vascular liver diseases: position papers from the francophone network for vascular liver diseases, the French Association for the Study of the Liver (AFEF), and ERN-rare liver. Clin Res Hepatol Gastroenterol, 2020, 44(4): 452-459.
9. Tang H, Song P, Wang Z, et al. A basic understanding of congenital extrahepatic portosystemic shunt: incidence, mechanism, complications, diagnosis, and treatment. Intractable Rare Dis Res, 2020, 9(2): 64-70.
10. Pupulim LF, Vullierme MP, Paradis V, et al. Congenital portosystemic shunts associated with liver tumours. Clin Radiol, 2013, 68(7): e362-e369.
11. Lautz TB, Shah SA, Superina RA. Hepatoblastoma in children with congenital portosystemic shunts. J Pediatr Gastroenterol Nutr, 2016, 62(4): 542-545.
12. 刘建新, 王贤明, 郭少文, 等. 超声诊断先天性肝内门静脉肝静脉瘘 1 例. 中华超声影像学杂志, 2011, 20(5): 435.
13. Golli M, Kriaa S, Said M, et al. Intrahepatic spontaneous portosystemic venous shunt: value of color and power Doppler sonography. J Clin Ultrasound, 2000, 28(1): 47-50.
14. Knirsch W, Benz DC, Bühr P, et al. Catheter interventional treatment of congenital portosystemic venous shunts in childhood. Catheter Cardiovasc Interv, 2016, 87(7): 1281-1292.
15. Bayona Molano MDP, Krauthamer A, Barrera JC, et al. Congenital intrahepatic portosystemic venous shunt embolization: a two-case experience. Clin Case Rep, 2020, 8(4): 761-766.
16. Allegritti M, Enrico B, Basile E, et al. Non-cirrhotic extra-hepatic porto-systemic shunt causing adult-onset encephalopathy treated with endovascular closure. Dig Dis Sci, 2020, 65(4): 946-951.
17. Tanoue S, Kiyosue H, Komatsu E, et al. Symptomatic intrahepatic portosystemic venous shunt: embolization with an alternative approach. AJR Am J Roentgenol, 2003, 181(1): 71-78.
18. Wu L, Zhao L, Lu Y, et al. Interventional embolization of congenital intrahepatic shunts in children. Pediatr Radiol, 2016, 46(4): 541-547.
19. 王玉贤, 张洪新, 李文献, 等. 金属弹簧栓子成功栓塞巨大肝动脉-门静脉瘘 1 例报告. 实用放射学杂志, 2004, 20(2): 120, 123.
20. Grimaldi C, Monti L, Falappa P, et al. Congenital intrahepatic portohepatic shunt managed by interventional radiologic occlusion: a case report and literature review. J Pediatr Surg, 2012, 47(2): e27-e31.
21. Suzuki K, Shimohira M, Hashizume T, et al. Dual microcather-dual detachable coil technique in embolization for a congenital intrahepatic portosystemic venous shunt (IPSVS). Minim Invasive Ther Allied Technol, 2013, 22(5): 316-318.
22. Power AH, Bjarnason H. Large spontaneous intrahepatic portal-systemic venous shunt treated with coil and Amplatzer vascular plug embolization. Perspect Vasc Surg Endovasc Ther, 2012, 24(2): 90-94.
23. 黄顺根. 先天性门体分流诊治进展. 临床外科杂志, 2013, 21(8): 646-649.
24. Sakamoto S, Kasahara M, Shigeta T, et al. Living donor liver transplantation for multiple intrahepatic portosystemic shunts after involution of infantile hepatic hemangiomas. J Pediatr Surg, 2011, 46(6): 1288-1291.
25. Sakamoto S, Shigeta T, Fukuda A, et al. The role of liver transplantation for congenital extrahepatic portosystemic shunt. Transplantation, 2012, 93(12): 1282-1287.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Combined laparoscopic and interventional therapy for congenital portosystemicshunt with hepatic focal nodular hyperplasia

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