生体部分肝移植後早期に妊娠出産し得た胆道閉鎖症の1例  [in Japanese] A Patient With Biliary Atresia who Achieved Pregnancy and Gave Birth Early After Living Donor Liver Transplantation  [in Japanese]

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<p>胆道閉鎖症術後,結婚し挙児希望のある25 歳女性.代償性肝硬変の状態により,小腸内腔に突出する大きな静脈瘤を認めていた.胆管炎による入院を契機に肝移植に関する情報提供を開始し,5 か月後に63 歳の父をドナーとする生体部分肝移植を施行した.術後は門脈血流不良,小腸穿孔,腸閉塞,胆管空腸吻合縫合不全のため計3 回の再開腹手術を要し,術後94 日目に退院した.肝移植5 か月後に残存した小腸静脈瘤の塞栓術を施行した.肝移植2 年後に妊娠し,母子ともに大きな問題なく妊娠38 週1 日に経腟分娩で健児を得た.慢性肝障害・肝硬変を有している胆道閉鎖症術後の成人症例では,妊娠・出産に大きなリスクを伴う.肝移植後の妊娠・出産に関しては安全にできるという報告が増えているが,挙児希望を理由に肝移植を施行することは一般的ではない.次世代を生み育てるまでの"成育医療"という観点で示唆に富む症例と思われ,ここに報告する.</p>

<p>A 25-year-old woman with biliary atresia after portoenterostomy, who was married and wished to give birth, visited our institution. She had compensated cirrhosis and large jejunoileal varices, which protrude into the intestinal lumen. At the time of her hospitalization due to cholangitis, we started to inform the patient and her family about the risks and benefits of liver transplantation. After five months, she underwent living donor liver transplantation from her father aged 63 years. Three re-laparotomy procedures were needed to correct poor portal blood flow, intestinal perforation, intestinal obstruction, and biliary-enteric anastomotic leakage; she was discharged three months after liver transplantation. Five months after liver transplantation, embolization of the remaining large jejunoileal varices was successfully performed. Two years after liver transplantation, she achieved pregnancy and gave birth to a healthy baby at 38 weeks of gestation with an uneventful course. Adult patients with biliary atresia after surgery, who have chronic liver damage and cirrhosis, have a great risk of deterioration at the time of pregnancy and delivery. Although good pregnancy outcomes after liver transplantation have been reported, the desire of giving birth is an uncommon indication for liver transplantation. The current case highly indicates the need for close monitoring of "child health and development", meaning that sick children should be cared for until they give birth to and rear the next generation.</p>

Journal

  • Journal of the Japanese Society of Pediatric Surgeons

    Journal of the Japanese Society of Pediatric Surgeons 52(5), 1103-1107, 2016

    The Japanese Society of Pediatric Surgeons

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