BACKGROUND: To evaluate feasibility and safety of venovenous bypass prior to mobilization of the liver during orthotopic liver transplantation (OLT). METHODS: Fifty-four patients were classified into two groups. Group...BACKGROUND: To evaluate feasibility and safety of venovenous bypass prior to mobilization of the liver during orthotopic liver transplantation (OLT). METHODS: Fifty-four patients were classified into two groups. Group A consisted of 23 patients receiving OLT with classical venovenous bypass. Group B consisted of 31 patients who received a modified-procedure: venovenous bypass ahead of the mobilization of the liver during ULT. The blood loss, duration of venovenous bypass, cold ischemia time, anhepatic phase, and transfusion during operation in the two groups were compared. Complications after the operation were also compared between the two groups. RESULTS: The duration of venovenous bypass and cold ischemia time in group A were longer than those in group B [(99.78±21.36 min) vs (96.32±22.25 min) and (484.78±134.01 min) vs (443.15± 85.27 min)]. The anhepatic phase lasted for about 100 min averagely in the two groups. The volumes of blood loss and transfusion during the operation were larger in group A than in group B [(5096±4243 ml) vs (1726±1125 ml) and (3676±2938.74 ml) vs (1217.69±829.72 ml)]. Postoperative complications occurred in 26 patients of group A and in 19 patients of group B. CONCLUSION: This modified-procedure or venovenous bypass ahead of mobilization of the liver in OLT can reduce the blood loss during OLT and the incidence of postoperative complications without prolongation of the anhepatic phase and duration of venovenous bypass.展开更多
A renal mass with level Level IV IVC thrombus is usually managed with radical nephrectomy and IVC thrombectomy. This procedure requires the assistance of a cardiac surgeon and is usually done under complete cardiopulm...A renal mass with level Level IV IVC thrombus is usually managed with radical nephrectomy and IVC thrombectomy. This procedure requires the assistance of a cardiac surgeon and is usually done under complete cardiopulmonary bypass. However, the use of cardiopulmonary bypass is associated with reduced cardiac venous return and can consequently decrease cardiac output, adversely affecting haemo-dynamic stability and systemic arterial perfusion. This can lead to relative ischemia of the abdominal viscera, lower limbs and kidneys. We report a case where radical nephrectomy with IVC thrombectomy was done under venovenous bypass, thus avoiding the complications associated with the cardiopulmonary bypass.展开更多
Background Liver transplantation in Budd-Chiari syndrome remains controversial; however, some improved techniques lead to better results. We report medium-term follow-up results of liver transplantation with atrioatri...Background Liver transplantation in Budd-Chiari syndrome remains controversial; however, some improved techniques lead to better results. We report medium-term follow-up results of liver transplantation with atrioatrial anastomosis for Budd-Chiari syndrome and explore the indications of liver transplantation with atrioatrial anastomosis for patients with end stage liver disease.Methods Nine patients （six Budd-Chiari syndromes, one end stage hepatolithiasis, one hepatocellular carcinoma and one incurable alveolar echinococcosis） underwent liver transplantation with atrioatrial anastomosis in West China Hospital of Sichuan University from 1999 to 2006. Eight liver transplants used cadaveric orthotopic livers and one a living donor liver. The operative technique was transdiaphragmatic exposure for direct atrioatrial anastomosis and replacement of inferior vena cava by cryopreserved vena cava graft with the help of venovenous bypass.Results All liver transplantations were successful. Two patients contracted pulmonary infection and acute rejection took place in another case. With proper treatment, all patients recovered well and had good quality of life. To date, they have been followed up for more than 24 months. The only death followed recurrence of hepatic carcinoma three years after liver transplantation.Conclusions Transdiaphragmatic exposure for direct atrioatrial anastomosis and the cryopreserved vena cava graftreplacement of inferior vena cava are possible for patients with end stage liver disease thus extending the indications of liver transplantation.展开更多
文摘BACKGROUND: To evaluate feasibility and safety of venovenous bypass prior to mobilization of the liver during orthotopic liver transplantation (OLT). METHODS: Fifty-four patients were classified into two groups. Group A consisted of 23 patients receiving OLT with classical venovenous bypass. Group B consisted of 31 patients who received a modified-procedure: venovenous bypass ahead of the mobilization of the liver during ULT. The blood loss, duration of venovenous bypass, cold ischemia time, anhepatic phase, and transfusion during operation in the two groups were compared. Complications after the operation were also compared between the two groups. RESULTS: The duration of venovenous bypass and cold ischemia time in group A were longer than those in group B [(99.78±21.36 min) vs (96.32±22.25 min) and (484.78±134.01 min) vs (443.15± 85.27 min)]. The anhepatic phase lasted for about 100 min averagely in the two groups. The volumes of blood loss and transfusion during the operation were larger in group A than in group B [(5096±4243 ml) vs (1726±1125 ml) and (3676±2938.74 ml) vs (1217.69±829.72 ml)]. Postoperative complications occurred in 26 patients of group A and in 19 patients of group B. CONCLUSION: This modified-procedure or venovenous bypass ahead of mobilization of the liver in OLT can reduce the blood loss during OLT and the incidence of postoperative complications without prolongation of the anhepatic phase and duration of venovenous bypass.
文摘A renal mass with level Level IV IVC thrombus is usually managed with radical nephrectomy and IVC thrombectomy. This procedure requires the assistance of a cardiac surgeon and is usually done under complete cardiopulmonary bypass. However, the use of cardiopulmonary bypass is associated with reduced cardiac venous return and can consequently decrease cardiac output, adversely affecting haemo-dynamic stability and systemic arterial perfusion. This can lead to relative ischemia of the abdominal viscera, lower limbs and kidneys. We report a case where radical nephrectomy with IVC thrombectomy was done under venovenous bypass, thus avoiding the complications associated with the cardiopulmonary bypass.
文摘Background Liver transplantation in Budd-Chiari syndrome remains controversial; however, some improved techniques lead to better results. We report medium-term follow-up results of liver transplantation with atrioatrial anastomosis for Budd-Chiari syndrome and explore the indications of liver transplantation with atrioatrial anastomosis for patients with end stage liver disease.Methods Nine patients （six Budd-Chiari syndromes, one end stage hepatolithiasis, one hepatocellular carcinoma and one incurable alveolar echinococcosis） underwent liver transplantation with atrioatrial anastomosis in West China Hospital of Sichuan University from 1999 to 2006. Eight liver transplants used cadaveric orthotopic livers and one a living donor liver. The operative technique was transdiaphragmatic exposure for direct atrioatrial anastomosis and replacement of inferior vena cava by cryopreserved vena cava graft with the help of venovenous bypass.Results All liver transplantations were successful. Two patients contracted pulmonary infection and acute rejection took place in another case. With proper treatment, all patients recovered well and had good quality of life. To date, they have been followed up for more than 24 months. The only death followed recurrence of hepatic carcinoma three years after liver transplantation.Conclusions Transdiaphragmatic exposure for direct atrioatrial anastomosis and the cryopreserved vena cava graftreplacement of inferior vena cava are possible for patients with end stage liver disease thus extending the indications of liver transplantation.
