背驮式同种原位肝移植术1例报告

PIGGYBACK ALLOGENEIC ORTHOTOPIC LIVER TRANSPLANTATION:A CASE REPORT

报告一位患原发性胆汁性肝硬化合并门静脉高压症的终末期病人作了背驮式同种原位肝移植术，手术获得成功，术后恢复良好。认为该术式由于保留受体的肝后下腔静脉，具有术中血液动力学稳定，肾功能不受影响，术后恢复快等优点，因此可以作为肝移植常规术式。但是对手术前一般情况差或者估计无肝期时间长的病人，采用背驮式手术时应加作门静脉—腋静脉（成人颈静脉）转流。作者提出了改良Ｓｔａｒｚｌ介绍的吻合肝动脉的生长因素法（ＧｒｏｗｔｈＦａｃｔｏｒ），不但适用于小动脉的吻合，也适用于静脉吻合，可以避免或减少吻合血管的狭窄和血栓形成。在胆管重建时强调保证胆管血供的重要性并且放弃了胆总管的Ｔ管引流法，改用经胆囊管插管引流，可以减少胆总管的损伤和术后胆管狭窄的机会。

Piggyback Allogeneic Orthotopic liver transplantation was performed successfully in a patient and primary biliary cirrhosis and portal hypertension on 26 July 1996 The operation took 8 hours and 30minutes The patient had a good post operative recover Piggyback operation can be routinely used in orthotopic liver transplantation,because this technique preserves the donor's retro hepatic inferior vena cava and therefore has several merits including hemodynamic stability during operation, preservation of normal renal function, quick recovery,etc. It is necessary to perform portal vein axillary vein(adult cervical vein) bypass in addition to this operation for weak patients or those having a longer anhepatic phase The authors presented a modified Starzl's Growth Factor method for hepatic artery anastomosis,which can be used not only for small artery anastomosis but also for venous anastomosis.It can avoid or reduce the chances of vascular stricture and thrombosis.The authors emphasized the significance of ensuring the biliary blood supply in biliary anastomosis The authors abandoned the common bile duct T tube drainage method,and adopted the cystic duct intubation drainage method,which can minimize the chances of common bile duct injury and post operative strictures of the bile ducts.