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腔静脉成型原位肝移植术

Analysis of cavaplasty technique in orthotopic liver transplantation
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摘要 目的 分析连续 7例腔静脉成型原位肝移植术结果 ,探讨其在原位肝移植中价值。 方法 应用标准的腔静脉成型技术于连续 7例原位肝移植 ,记录手术及无肝期时间、输血量、术后并发症及随访情况。 结果  7例肝移植均未采用静脉转流技术 ,手术时间为 4 2 6± 4 0 (380~ 4 70 )min ,无肝期为 88± 8(80~ 10 5 )min。术中输血为 12 0 0± 980 (40 0~ 2 80 0 )ml。术后 3例出现胸腔积液 ,其中 1例为血性 ,经抽吸后愈 ;1例术后 3个月拔T管时胆漏 ,保守后愈 ;1例神经精神障碍 ;余无其他严重并发症发生 ,无手术死亡。术后随访 ,前 3例分别存活 17个月、8个月和 5个月 ,生活质量良好 ;7例术后分别随访 17个月、8个月、5个月、3个月、2个月、个 7周和 4周 ,均已出院 ,恢复良好。 结论 腔静脉成型技术与两大传统肝移植术式相比 ,既具有类似于背驮式肝移植保留肝后下腔静脉的优点 ,又吸取经典肝移植病肝切除简便快速的优点 ,简化了肝短静脉和肝后腔静脉解剖步骤 ,缩短了手术时间 ,宽大的肝后腔静脉吻合口保证了流出道畅通 ,减少了肝移植手术血管并发症的发生率。该技术容易掌握 ,特别适合肝移植的初期阶段。 Objective To assess the efficiency of cavaplast y technique in orthotopic liver transplantation (OLT) by the outcome of 7 consiste nt cases. Methods Utilizing standard cavaplasty technique co nsistently in 7 cases of OLT from January 2003 to April 2004. The data of operat ive time, anhepatic phase, transfusion units, complications and follow up were c ollected and analyzed. Results The operative times of 7 cas es were 380~470(426±40)min,and anhepatic phases were 80~95(88±8)min. No ven o-venous bypass was performed in all of cases. Blood transfused from 400 to 280 0 (1200±980)ml. Hydrothorax was found in 3 cases with bloody hydrothorax in one , one case had bile leakage occurred 3 months postoperatively after T tube withd rawal. No other complications occurred and the operation mortality was zero. Sev en cases have been followed up for 17months, 8months, 5months, 3months, 2months, 7weeks, and 4weeks respectively with satisfied recovery and life quality. Conclusion Cavaplasty technique utilized in OLT possess the advant age of piggyback OLT in preserving retrohepatic cava, at the same time, simplifi es the dissection procedures for short hepatic vein. The wide triangular caval a nastomosis assures the patency of outflow for graft and reduces the vascular com plication greatly in OLT. This technique is easy to be followed and is more suit able to perform in the beginning period of liver transplantation.
出处 《现代实用医学》 2004年第9期516-518,521,共4页 Modern Practical Medicine
基金 宁波市科委社会攻关基金资助 基金编号 0 0 2 60 1。
关键词 肝硬化 肝肿瘤 癌症 肝移植 原位 腔静脉成型 Liver cirrhosis Liver neoplasms Carcinoma Liver t ransplantation Cavaplasty
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