背驮式肝移植技术改良(附41例次临床病例分析)

The Ameliorations of the Technique of Piggyback Liver Transplantation (Analysis of 41 Cases)

目的 探讨背驮式肝移植在终末期肝病中应用的利弊。 方法 自 1 995年 9月至 2 0 0 0年 7月 ,对 39例患者施行了 41次背驮式肝移植。作者对供肝静脉回流通道重建技术进行了逐步改变 ,由供肝下腔静脉与受体成型的肝静脉重建 ,到供、受体下腔静脉的端 -侧吻合及侧 -侧吻合 ,并进行了供体下腔静脉与受体下腔静脉 -右心房的桥式吻合和原旁位供肝肝上下腔静脉 -右心房重建悬吊。 结果 手术技术的改良既避免了肝静脉回流不同程度受阻的弊端 ,同时缩短了无肝期和下半躯体淤血时间。 结论 背驮式肝移植技术改良减少了术后并发症 ,缩短了手术时间 ,并拓宽了手术适应证。

Objective To discuss the advantages and the disadvantages of the technique of Piggy back liver transplantation (PBLT) and to find the most reasonable methods for different end stage liver diseases. Methods 41 PBLTx have been performed from September 1995 to July 2000 in 39 cases. The methods of reconstruction of the hepatic veins have been improved by the authors. The end to end anastomosis of donor's IVC to the concluded hepatic veins was done in the early period, and then the end to side anastomosis of the donor's IVC to the recipient's IVC and finally to the recipient's atrium was established; besides the orthotopic inferior vena cava to atrium bridge PBLTx, the auxiliary paraorthotopic inferior vena cava to atrium bridge PBLTx (pending PBLTx) were also performed. Results The amelioration of the technique of PBLTx is helpful to avoid the syndromes of the hepatic occlusion and shorten the nonhepatic phase as well as the time of the venous stasis of the lower body. Conclusion The amelioration of PBLT reduced the side effects after operation, shortened the time of the operation and widened the indications of liver transplantation.