肝后腔静脉成形术行原位肝移植103例

Suprahepatic venacavaplasty in liver transplantation: an analysis of 103 cases

目的:探讨肝移植新术式肝后腔静脉成形术在人原位肝移植中的应用价值.方法:应用改良肝移植新术式肝后腔静脉成形术行原位肝移植103例,观察其手术所用时间、无肝期、术中出血量及并发症等.结果:本组无1例发生围手术期死亡.肝后腔静脉成形术手术所用时间及无肝期(6.8±0.8h,52.6±14.5min)显著短于同期报告资料经典式肝移植(7.4±0.6h,86.5±7.1min)以及改良背驮式肝移植(7.9±0.6h,78.4±7.94min).术中出血量(2960±1120mL)也显著少于改良背驮式(4662±913mL)和经典式肝移植(4441±1072mL).肝后腔静脉成形术术后肾功能不全发生率为29.1%(30/103),与经典式肝移植相近,比改良背驮式高,但均能在术后3-4wk内恢复正常.结论:肝移植新术式肝后腔静脉成形术能简化病肝切除和新肝植入的手术操作,缩短手术时间,减少术中出血,值得临床进一步推广应用.

AIM： To explore the values of suprahepatic venacavaplasty （cavaplasty） in liver transplantation. METHODS： The new orthotopic liver transplantation procedure combined with cavaplasty was conducted in 103 patients. RESULTS： There were no perioperative deaths in this study. The median operative and anhepatic-phase time in cavaplasty group （6.8 ± 0.8 h and 52.6 ± 14.5 min, respectively） were significantly shorter than those in classic and modified piggyback groups （7.4 ±0.6 h, 86.5 ± 7.1 min; 7.9 ± 0.6 h, 78.4 ± 7.94 min） reported recently by other data, and blood loss was also less in cavaplasty group （2960 ± 1120 mL） than those in latter two groups （4662 ± 913 mL; （4662± 1072 mL）. Post-operative acute renal failure occurred in 30 cases （29.1%）, similar to that in classic group but higher than that in modified piggyback group. All the patients with acute renal failure recovered within 3 to 4 weeks. CONCLUSION： Cavaplasty can simplify the resection procedure of the diseased liver and implantation of new liver, and reduce the operative time and blood loss during transplantation process, indicating that cavaplasty is safe, and should be clinically recommended.