体外静脉－静脉转流在肝移植手术中的应用

Application of Extracorporeal Veno-Venous Bypass in Liver Transplantation

使用离心泵行体外静脉－静脉（Ｖ－Ｖ）转流的技术，成功地应用于２例同种异体原位肝移植手术。结果表明：（１）肝移植手术使用Ｖ－Ｖ转流，腹腔内脏及下肢血液循环得到保证，避免了无肝期酸硷平衡失调和开放循环后电解质的紊乱；（２）使用离心泵能较好地控制转流期间体内外血流量的平衡，维持血流动力学的稳定；（３）血液变温器的使用可防止转流中及术后低温；（４）部分肝素化使激活凝血时间（ＡＣＴ）控制在２００秒左右，既可预防转流中循环管道系统凝血，又可避免因全身肝素化使手术出血增加。

Two allogenic orthotopic liver transplantations were successfully performed at our hospital.A technique of veno-venous bypass with centrifugal pump was used during the anhepatic phase.Our observations may be summed up as follows:(1)With Sarns Delphin Ⅱ(USA)centrifugal pump, a well balanced venous bypass was made without significant hemodynamic change.(2)The use of Sarns heat exchanger prevented development of hypothermia.(3)With partial heparinization,ACT was controlled around 200 seconds.The abdominal viscera and lower extremities were satisfactorily perfused.Therefore,during the anhepatic phase,hyperkalemia and production of acidic metabolites were avoided and other pathophysiological changes were minimized.Less blood less and drier operating field also contributed to the success.