Objective: To assess the feasibility and outcome of orthotopic liver transplantation(OLT) with no veno-venous bypass(v-v bypass) in adult patients. Methods: Between 1999 and 2001, 43 adult patients underwent OLT with ...Objective: To assess the feasibility and outcome of orthotopic liver transplantation(OLT) with no veno-venous bypass(v-v bypass) in adult patients. Methods: Between 1999 and 2001, 43 adult patients underwent OLT with v-v bypass, 33 with no v-v bypass. The operation time, anhepatic time, amount of blood loss, amount of blood transfusion, ICU stay days of the two groups were compared; renal function and gastrointestinal function in the two groups were examined. Results: There was no significant difference in mean serum creatinine on day 3 and gas discharge time in patients with v-v bypass or not. With no v-v bypass , the average operation time was 5.7±1.3 hours, anhepatic time was 64±13 minutes, median amount of blood loss in operation was 4000±820 mL, median amount of blood transfused intraoperatively was 4650±910 mL, median ICU stay was 5.7 days; all those were lower or shorter than those with v-v bypass; and these differences between the two groups had statistical significances. Conclusion: OLT with no v-v bypass is safe and can be performed in the majority of adult patients. The practice of liver transplantation with no v-v bypass is associated with shorter total operation time, shorter anhepatic time, lower blood product usage, and shorter ICU stay compared with standard technique of OLT with routine use of v-v bypass.展开更多
BACKGROUND: The clearance of propofol is very rapid, and its transformation takes place mainly in the liver. Some reports indicated extrahepatic clearance of the drug and that the lungs are the likely place where the ...BACKGROUND: The clearance of propofol is very rapid, and its transformation takes place mainly in the liver. Some reports indicated extrahepatic clearance of the drug and that the lungs are the likely place where the process occurs. This study was undertaken to compare the plasma concentrations of propofol both in the pulmonary and radial arteries after constant infusion during the dissection, anhepatic and reperfusion phases of orthotopic liver transplantation (OLT) without veno-venous bypass, attempting to investigate extrahepatic clearance and to determine whether the human lungs take part in the elimination of propofol. METHODS: Fifteen patients undergoing OLT without veno-venous bypass were enrolled in the study, and propofol was infused via a forearm vein at a rate of 2 mg· kg-1·h-1. Blood samples were simultaneously collected from pulmonary and radial arteries at the end of the first hepatic portal dissection (T0), at the clamping of the portal vein (T1), 30, and 60 minutes after the beginning of the anhepatic phase (T2, T3), and 30, 60, and 120 minutes after the unclamping of the new liver (T4, T5, T6). Plasma propofol concentrations were measured using a reversed- phase, high-performance liquid chromatographic method with fluorescence detection. RESULTS: The concentrations of plasma propofol in the pulmonary and radial arteries at T2 and T3 rose significantly compared with T0 and T1 (P<0.01) respectively. After reperfusion, the drug concentrations at T4, T5 and T6 decreased significantly compared with T2, T3 (P<0.01)respectively. There were no significant differences in plasma propofol concentrations between the pulmonary and radial arteries at any time points. CONCLUSIONS: Propofol is eliminated mainly by the liver, and also by extrahepatic organs. The lungs seem to be not a major site contributing to the extrahepatic metabolism of propofol in humans.展开更多
There are several caval reconstruction techniques currently in use for orthotopic liver transplantation. These include caval replacement or the conventional technique, performed with or without venovenous bypass, pigg...There are several caval reconstruction techniques currently in use for orthotopic liver transplantation. These include caval replacement or the conventional technique, performed with or without venovenous bypass, piggyback technique with anastomosis with two or three hepatic veins with or without cavotomy and modifications of the piggyback technique including end-to-side and side-to-side cavocaval anastomosis. There are few randomized controlled trials comparing the use of these techniques and our knowledge of their comparability is based on a few multi- and many single-center retrospective and prospective reviews. Although there are advantages and disadvantages for each technique, it is advisable that the surgeon perform the technique with which they have the most the experience and at which they are the most skilled as excellent outcomes can be obtained with any of the caval reconstruction options discussed.展开更多
Objective: To sum up the experience in liver trans- plantation in a period of ten years at a single center. Methods: We retrospectively reviewed the clinical re- cords of 120 patients receiving liver transplantation f...Objective: To sum up the experience in liver trans- plantation in a period of ten years at a single center. Methods: We retrospectively reviewed the clinical re- cords of 120 patients receiving liver transplantation from April 1993 to October 2002. The patients' cli- nical characteristics, surgical techniques, complica- tions and survival were compared in the phases of 1993-1997 (phase Ⅰ), 1999 (phase Ⅱ), and 2000- 2002 (phase Ⅲ). Results: Malignant liver diseases were major indica- tions for liver transplantation in phase Ⅰ(100%) and Ⅱ(53. 3%), but decreased markedly in percentage in phase Ⅲ(34. 0%). When compared with recipi- ents in phase Ⅰ and Ⅱ, the survival of recipients with benign liver diseases in phase Ⅲ was significantly im- proved with the 3-month, 6-month and 1-year sur- vival rates of 85. 7%, 84. 5% and 83. 1%, respec- tively. For patients with malignant liver diseases, the 3-month, 6-month and 1-year survival rates were 87. 4%, 81. 1% and 46. 0%, respectively. The rein- fection rate of hepatitis B virus was 24% 12 months after transplantation. With technical refinements, the incidence of postransplantation vascular compli- cations has significantly decreased from 29. 4% in phase Ⅰ and Ⅱ to 4. 9% in phase Ⅲ. Biliary compli- cations remained one of the major obstacles to long- term survival. No reno-venous bypass was applied in phase Ⅲ, providing a promising outcome. Conclusion: Strict selection of potential recipients, technical refinement, appropriate management of vascular and biliary complications, and prophylaxis of recurrences of hepatitis B and malignant liver dis- eases are important to obtain long-term survival of patients receiving liver transplantation in China.展开更多
目的:观察非静脉转流下,经典原位肝移植病人围术期电解质浓度和血流动力学变化。方法:9例经典原位肝移植病人在非静脉转流下,行气管插管静吸复合麻醉,术中经颈静脉双腔管持续监测CVP,桡动脉置管监测ABP。于手术各期定时抽取桡动脉血行...目的:观察非静脉转流下,经典原位肝移植病人围术期电解质浓度和血流动力学变化。方法:9例经典原位肝移植病人在非静脉转流下,行气管插管静吸复合麻醉,术中经颈静脉双腔管持续监测CVP,桡动脉置管监测ABP。于手术各期定时抽取桡动脉血行血气分析,测定钠、钾、钙浓度。常规持续监测HR,SpO2,PETCO2及体温。结果:本组9例围手术期血钙持续偏低,无肝期和再灌注前期尤为明显。无肝期前期(5 m in)及再灌注前期(5 m in)血钾轻度上升,无肝期中期(30 m in)及再灌注中期(30 m in)血钠轻度上升,但极少超出正常范围,病人血流动力学稳定后逐渐恢复诱导后水平。进入无肝期后,大部分病人血压一过性明显下降,其余时间段均较平稳。结论:非静脉转流原位肝移植,无肝期及再灌注期应注意纠正低血钙,无肝期前期(5 m in)及再灌注前期(5 m in)应警惕高血钾发生。进入无肝期前应适当扩容,无肝期中应用血管活性药物维持血压,及时根据病人失血量及血球压积补充血容量,尽可能维持围术期循环稳定,防止再灌注前期严重酸中毒的发生。展开更多
文摘Objective: To assess the feasibility and outcome of orthotopic liver transplantation(OLT) with no veno-venous bypass(v-v bypass) in adult patients. Methods: Between 1999 and 2001, 43 adult patients underwent OLT with v-v bypass, 33 with no v-v bypass. The operation time, anhepatic time, amount of blood loss, amount of blood transfusion, ICU stay days of the two groups were compared; renal function and gastrointestinal function in the two groups were examined. Results: There was no significant difference in mean serum creatinine on day 3 and gas discharge time in patients with v-v bypass or not. With no v-v bypass , the average operation time was 5.7±1.3 hours, anhepatic time was 64±13 minutes, median amount of blood loss in operation was 4000±820 mL, median amount of blood transfused intraoperatively was 4650±910 mL, median ICU stay was 5.7 days; all those were lower or shorter than those with v-v bypass; and these differences between the two groups had statistical significances. Conclusion: OLT with no v-v bypass is safe and can be performed in the majority of adult patients. The practice of liver transplantation with no v-v bypass is associated with shorter total operation time, shorter anhepatic time, lower blood product usage, and shorter ICU stay compared with standard technique of OLT with routine use of v-v bypass.
文摘BACKGROUND: The clearance of propofol is very rapid, and its transformation takes place mainly in the liver. Some reports indicated extrahepatic clearance of the drug and that the lungs are the likely place where the process occurs. This study was undertaken to compare the plasma concentrations of propofol both in the pulmonary and radial arteries after constant infusion during the dissection, anhepatic and reperfusion phases of orthotopic liver transplantation (OLT) without veno-venous bypass, attempting to investigate extrahepatic clearance and to determine whether the human lungs take part in the elimination of propofol. METHODS: Fifteen patients undergoing OLT without veno-venous bypass were enrolled in the study, and propofol was infused via a forearm vein at a rate of 2 mg· kg-1·h-1. Blood samples were simultaneously collected from pulmonary and radial arteries at the end of the first hepatic portal dissection (T0), at the clamping of the portal vein (T1), 30, and 60 minutes after the beginning of the anhepatic phase (T2, T3), and 30, 60, and 120 minutes after the unclamping of the new liver (T4, T5, T6). Plasma propofol concentrations were measured using a reversed- phase, high-performance liquid chromatographic method with fluorescence detection. RESULTS: The concentrations of plasma propofol in the pulmonary and radial arteries at T2 and T3 rose significantly compared with T0 and T1 (P<0.01) respectively. After reperfusion, the drug concentrations at T4, T5 and T6 decreased significantly compared with T2, T3 (P<0.01)respectively. There were no significant differences in plasma propofol concentrations between the pulmonary and radial arteries at any time points. CONCLUSIONS: Propofol is eliminated mainly by the liver, and also by extrahepatic organs. The lungs seem to be not a major site contributing to the extrahepatic metabolism of propofol in humans.
文摘There are several caval reconstruction techniques currently in use for orthotopic liver transplantation. These include caval replacement or the conventional technique, performed with or without venovenous bypass, piggyback technique with anastomosis with two or three hepatic veins with or without cavotomy and modifications of the piggyback technique including end-to-side and side-to-side cavocaval anastomosis. There are few randomized controlled trials comparing the use of these techniques and our knowledge of their comparability is based on a few multi- and many single-center retrospective and prospective reviews. Although there are advantages and disadvantages for each technique, it is advisable that the surgeon perform the technique with which they have the most the experience and at which they are the most skilled as excellent outcomes can be obtained with any of the caval reconstruction options discussed.
文摘Objective: To sum up the experience in liver trans- plantation in a period of ten years at a single center. Methods: We retrospectively reviewed the clinical re- cords of 120 patients receiving liver transplantation from April 1993 to October 2002. The patients' cli- nical characteristics, surgical techniques, complica- tions and survival were compared in the phases of 1993-1997 (phase Ⅰ), 1999 (phase Ⅱ), and 2000- 2002 (phase Ⅲ). Results: Malignant liver diseases were major indica- tions for liver transplantation in phase Ⅰ(100%) and Ⅱ(53. 3%), but decreased markedly in percentage in phase Ⅲ(34. 0%). When compared with recipi- ents in phase Ⅰ and Ⅱ, the survival of recipients with benign liver diseases in phase Ⅲ was significantly im- proved with the 3-month, 6-month and 1-year sur- vival rates of 85. 7%, 84. 5% and 83. 1%, respec- tively. For patients with malignant liver diseases, the 3-month, 6-month and 1-year survival rates were 87. 4%, 81. 1% and 46. 0%, respectively. The rein- fection rate of hepatitis B virus was 24% 12 months after transplantation. With technical refinements, the incidence of postransplantation vascular compli- cations has significantly decreased from 29. 4% in phase Ⅰ and Ⅱ to 4. 9% in phase Ⅲ. Biliary compli- cations remained one of the major obstacles to long- term survival. No reno-venous bypass was applied in phase Ⅲ, providing a promising outcome. Conclusion: Strict selection of potential recipients, technical refinement, appropriate management of vascular and biliary complications, and prophylaxis of recurrences of hepatitis B and malignant liver dis- eases are important to obtain long-term survival of patients receiving liver transplantation in China.
文摘目的:观察非静脉转流下,经典原位肝移植病人围术期电解质浓度和血流动力学变化。方法:9例经典原位肝移植病人在非静脉转流下,行气管插管静吸复合麻醉,术中经颈静脉双腔管持续监测CVP,桡动脉置管监测ABP。于手术各期定时抽取桡动脉血行血气分析,测定钠、钾、钙浓度。常规持续监测HR,SpO2,PETCO2及体温。结果:本组9例围手术期血钙持续偏低,无肝期和再灌注前期尤为明显。无肝期前期(5 m in)及再灌注前期(5 m in)血钾轻度上升,无肝期中期(30 m in)及再灌注中期(30 m in)血钠轻度上升,但极少超出正常范围,病人血流动力学稳定后逐渐恢复诱导后水平。进入无肝期后,大部分病人血压一过性明显下降,其余时间段均较平稳。结论:非静脉转流原位肝移植,无肝期及再灌注期应注意纠正低血钙,无肝期前期(5 m in)及再灌注前期(5 m in)应警惕高血钾发生。进入无肝期前应适当扩容,无肝期中应用血管活性药物维持血压,及时根据病人失血量及血球压积补充血容量,尽可能维持围术期循环稳定,防止再灌注前期严重酸中毒的发生。
