背驮式原位肝移植流出道梗阻的原因分析及处理(附6例临床报告)

Cause and management of outflow obstruction in piggyback liver transplantation:a clinical report of 6 cases

目的探讨背驮式肝移植流出道梗阻的原因及处理方法。方法回顾性分析我中心2002年1月至2003年9月实施的329例肝移植病例,其中经典非转流152例,经典转流31例,改良背驮式146例。6例出现明确的流出道梗阻,对这一并发症的临床表现及处理进行分析。结果这6例病人中,2例表现为急性Budd-Chiari综合征,其中1例剖腹探查,纠正吻合口扭转。另1例因同时伴有严重的肝功能障碍,急诊行二次肝移植;1例CT表现为左外侧叶淤血,未做特殊处理;另外3例手术关腹时血压、中心静脉压下降,右肝后加垫后缓解。结论背驮式肝移植流出道梗阻的发生与腔静脉吻合方式及供肝与受体是否匹配有关;术前详细地评估供受体条件并选择术式,术中及时发现并发症的存在并处理,可减少这一并发症带来的不良后果。

Objective To analyze the reasons for outflow obstruction in piggyback liver transplantation and its management. Methods From January 2002 to September 2003, a total of 329 cases received liver transplantation in our hospital. Of these 329 cases, 152 underwent standard orthotopic liver transplantation （OLT） without venouvenous bypass, 31 standard OLT and 146 modified Piggyback liver transplantation. Six of the last 146 cases presented with outflow obstruction. Results Two of the 6 cases presented with acute Budd-Chiari syndrome. Of the 2 cases, 1 received re-operation and modified mislocation of graft and the other underwent retransplantation. One case had congestion of the left lobe and required no special additional treatment. The remaining 3 cases presenting with increase in blood pressure and CVP upon omental closing were successfully treated during the operation. Conclusions The type of cavocaval anastomosis and inadequate graft size seem to be correlated to the occurrence of outflow obstruction in piggyback liver transplantation.