体外静脉转流技术在肝脏移植中的选择与应用的研究进展

Research Progress in the Selection and Application of Veno-venous Bypass Technique in Liver Transplantation

体外静脉转流(VVB)技术是一种肝脏移植辅助技术,它在一定程度上可以避免因门静脉及下腔静脉血流阻断而造成的血流动力学紊乱。但目前VVB适应证选择尚无明确标准,其主要适应证有试验性血流阻断后血流动力学不稳定、心脏功能不全、肾脏功能不全、暴发性肝功能衰竭、严重门静脉高压,以及用于减少手术中出血等。VVB具有维持血流动力学稳定、维持体温、降低门静脉压力、进行液体容量管理及可进行血液透析等优点,但随着肝脏移植外科技术及肝脏移植麻醉日臻成熟,VVB的部分优点逐渐被掩盖,这也在一定程度上造成了国内外不同肝脏移植中心经验性选择VVB的差异。VVB与肝移植过程合理配合能使手术过程更加平稳,但目前仍缺乏VVB适应证选择与否的大样本随机对照研究。

Veno-venous bypass（VVB） is an assistive technology for liver transplantation, the main role of which is to overcome the hemodynamic disturbances caused by vascular occlusion of the portal vein and the inferior vena cava. Now there is still no established criteria for VVB selecting and application. The main indi- cations for using VVB are hemodynamic instability after main blood vessel trialocclusion, cardiac insufficiency, renal dysfunction, fulminant hepatic failure, severe portal hypertension, and reducing bleeding during liver transplantation operation. VVB can maintain hemodynamic stability and body temperature, reduce portal pres- sure, manage the liquid capacity and hemodialysis, however, advancements in transplant anesthesiology, tech- nical refinements of the liver transplantation procedure, and improvements in surgical skills have gradually covered the advantages of VVB,. which causes differences in VVB selection in diffenret liver transplant centers in the world. Appropriate VVB application during liver transplantation can make the operation more steady,though it is still lack of large randomized controlled study for VVB indications.