腔静脉成形术在原位肝移植中的应用(附63例报道)

Cavaplasty in liver transplantation (Report of 63 cases)

目的 对腔静脉成形术这种新的肝移植术式进行评价。方法 总结 2 0 0 2年 6月～ 2 0 0 4年 6月采用腔静脉成形术完成的 6 3例原位肝移植患者的临床资料 ,并与同期采用经典原位肝移植技术完成的 32例肝移植患者的资料进行对比。结果 腔静脉成形肝移植组术中大剂量血管收缩药的应用、术后腹腔出血再次探查和术后肾功能衰竭的发生率较经典原位肝移植组显著减少 (P <0 .0 5 ) ;前者未发生腔静脉并发症 ,后者发生腔静脉并发症 4例 ;腔静脉成形肝移植组的手术时间为 (5 .3± 1.9)h ,明显短于经典原位肝移植组的 (7.7± 2 .5 )h(P <0 .0 1) ;腔静脉成形肝移植组的无肝期时间为 (6 2± 13)min ,经典原位肝移植组为 (73± 19)min ,两组差异无显著性 (P >0 .0 5 ) ;腔静脉成形肝移植组的失血量和输血量分别为 (2 10 0± 114 0 )ml和 (2 4 0 0± 110 0 )ml,均明显少于经典原位肝移植组的 (4 380± 2 10 0 )ml和 (4 80 0± 170 0 )ml(P值均 <0 .0 1) ;腔静脉成形肝移植组的术后腹腔引流量为 (970± 2 30 )ml,明显少于经典原位肝移植组的 (116 0± 310 )ml(P <0 .0 5 )。两组拔除气管插管时间、重症监护室留置时间和住院时间的差异无显著性。结论 腔静脉成形肝移植术无需解剖肝后腔静脉 ,肝下腔静脉得以保留 。

Objective To introduce a new liver transplantation technique and to assess the outcome of cavaplasty OLT. Methods To compare 63 cases of liver transplantation by cavaplasty procedure with 32 cases of liver transplantation by standard orthotopic liver transplantation (OLT) between June, 2002 and June, 2004. Results The results of Cavaplasty technique group and standard OLT group were as follows: operative duration: [(5.3+1.9) h vs (7.7+ 2.5) h,P< 0.01]; anhepatic phase: (62±13) min vs (73±19) min, P>0.05; Blood loss: (2 100 ±1 140) ml vs (4 380±2 100) ml (P<0.01); Blood transfusion: (2 400±1 100) ml vs (4 800±1 700) ml (P <0.01); Volume of drainage within one day after transplantation: (970±230) ml vs (1 160±310) ml (P<0.05); No venacava complication occurred in modified PB (cavaplasty) group, but in 4 cases of standard OLT group. Conclusion The cavaplasty technique does not require retrocaval dissection and the inferior vena cava can be preserved providing advantages for hepatectomy and easier hemostasis. This triangular caval anastomosis is easy to perform, allowing short anhepatic phase and avoiding outflow obstruction. Our experience indicates that the cavaplasty technique is eligible for patients. (Shanghai Med J, 2004,27: 811-813)