The last decade saw increased organ donation activity from donors after cardiac death (DCD). This contributed to a signif icant proportion of transplant activity. Despite certain drawbacks, liver transplantation from ...The last decade saw increased organ donation activity from donors after cardiac death (DCD). This contributed to a signif icant proportion of transplant activity. Despite certain drawbacks, liver transplantation from DCD donors continues to supplement the donor pool on the backdrop of a severe organ shortage. Understanding the pathophysiology has provided the basis for modulation of DCD organs that has been proven to be effective outside liver transplantation but remains experimental in liver transplantation models. Research continues on how best to further increase the utility of DCD grafts. Most of the work has been carried out exploring the use of organ preservation using machine assisted perfusion. Both ex-situ and in-situ organ perfusion systems are tested in the liver transplantation setting with promising results. Additional techniques involved pharmacological manipulation of the donor, graft and the recipient. Ethical barriers and end-of-life care pathways are obstacles to widespread clinical application of some of the recent advances to practice. It is likely that some of the DCD offers are in fact probably "prematurely" of-fered without ideal donor management or even prior to brain death being established. The absolute benef its of DCD exist only if this form of donation supplements the existing deceased donor pool; hence, it is worthwhile revisiting organ donation process enabling us to identify counter remedial measures.展开更多
[摘要]目的探讨腹腔镜胆总管探查（1aparoscopic common bile duct exploration，LCBDE）一期缝合术治疗复发性胆总管结石的可行性和安全性。方法回顾性分析2010年1月至2014年6月间行LCBDE一期缝合术的45例复发性胆总管结石病人的临床...[摘要]目的探讨腹腔镜胆总管探查（1aparoscopic common bile duct exploration，LCBDE）一期缝合术治疗复发性胆总管结石的可行性和安全性。方法回顾性分析2010年1月至2014年6月间行LCBDE一期缝合术的45例复发性胆总管结石病人的临床资料。结果45例病人无中转开腹及围手术期死亡病例。术中2例分别损伤横结肠、十二指肠球部浆膜。手术时间为76～155min，平均（108．5±35．4）min；术中出血量为10～115ml，平均（35．6±10．5）ml；术后肛门排气时间为1～4d，平均（1．2±0．5）d；术后住院时间为5～15d，平均（7．2±3．2）d。术后并发症总发生率为6．25％（3／48），其中胆漏2例，高淀粉酶血症1例，均经保守治疗后治愈；无再手术病例。43例病人完成术后1年随访，随访率为93．75％，均经影像学检查证实无胆管狭窄、胆管残留结石或结石复发等并发症。结论选择性LCBDE一期缝合术治疗复发性胆总管结石是安全有效的，短期预后良好。但术者需具备丰富的腹腔镜操作经验，并灵活地把握手术适应证。展开更多
文摘The last decade saw increased organ donation activity from donors after cardiac death (DCD). This contributed to a signif icant proportion of transplant activity. Despite certain drawbacks, liver transplantation from DCD donors continues to supplement the donor pool on the backdrop of a severe organ shortage. Understanding the pathophysiology has provided the basis for modulation of DCD organs that has been proven to be effective outside liver transplantation but remains experimental in liver transplantation models. Research continues on how best to further increase the utility of DCD grafts. Most of the work has been carried out exploring the use of organ preservation using machine assisted perfusion. Both ex-situ and in-situ organ perfusion systems are tested in the liver transplantation setting with promising results. Additional techniques involved pharmacological manipulation of the donor, graft and the recipient. Ethical barriers and end-of-life care pathways are obstacles to widespread clinical application of some of the recent advances to practice. It is likely that some of the DCD offers are in fact probably "prematurely" of-fered without ideal donor management or even prior to brain death being established. The absolute benef its of DCD exist only if this form of donation supplements the existing deceased donor pool; hence, it is worthwhile revisiting organ donation process enabling us to identify counter remedial measures.
文摘[摘要]目的探讨腹腔镜胆总管探查（1aparoscopic common bile duct exploration，LCBDE）一期缝合术治疗复发性胆总管结石的可行性和安全性。方法回顾性分析2010年1月至2014年6月间行LCBDE一期缝合术的45例复发性胆总管结石病人的临床资料。结果45例病人无中转开腹及围手术期死亡病例。术中2例分别损伤横结肠、十二指肠球部浆膜。手术时间为76～155min，平均（108．5±35．4）min；术中出血量为10～115ml，平均（35．6±10．5）ml；术后肛门排气时间为1～4d，平均（1．2±0．5）d；术后住院时间为5～15d，平均（7．2±3．2）d。术后并发症总发生率为6．25％（3／48），其中胆漏2例，高淀粉酶血症1例，均经保守治疗后治愈；无再手术病例。43例病人完成术后1年随访，随访率为93．75％，均经影像学检查证实无胆管狭窄、胆管残留结石或结石复发等并发症。结论选择性LCBDE一期缝合术治疗复发性胆总管结石是安全有效的，短期预后良好。但术者需具备丰富的腹腔镜操作经验，并灵活地把握手术适应证。
