不作转流的经典式原位肝移植术(附15例报道)

Classic Orthotopic Liver Transplantation without Venovenous Bypass ( A Report of 15 Cases)

目的 观察不转流的经典式原位肝移植的效果 ,分析不转流对胃肠道及肾脏功能的影响。 方法 1 999年以来我所共为 1 5例终末期肝病患者施行了不转流的经典式原位肝移植术。术中门静脉阻断时间平均为 40 .5min ,下腔静脉阻断时间 5 8.7min ;无肝期血压维持在 78～ 96 /5 2～ 6 4mmHg。开放门静脉后从肝下下腔静脉放血 1 5 0～ 2 0 0ml。 结果 1 5例一月内除 1例术后第 7天死于DIC外 ,余 1 4例无一例发生与不转流相关的胃肠道和肾功能明显损害的并发症。 结论 不转流经典式原位肝移植若无肝期小于 1h和血压在 80 /5 0mmHg以上 ,并不增加胃肠道和肾脏功能损害等并发症 ,有手术时间短和节省费用等优点。

Objective To observe the result of classic orthotopic liver transplantation without venovenous bypass and analyze the influence of non bypass on gastro intestinal tract and renal function. Methods 15 cases of classic orthotopic liver transplantation without bypass have been performed for end stage liver disease since 1999. The mean portal vein blocked time was 40.5 minutes, and the vena cava blocked time was 58.7 minutes. The blood pressure was maintained within 78 96/52 64 mmHg during anhepatic peroid. Results 14 cases had a good result without any gastro intestinal and renal complication which was related to non bypass.One case died of DIC in 7th day after the operation. Conclusion Classic orthotopic liver transplantation can be successfully performed if the vena cava blocked time is controlled within one hour with a stable blood pressure over 80/50 mmHg,which provides the advantage of time and money saving.