肝移植中肝脏左旋显露手法对血流动力学的影响

目的:通过观察肝移植中切肝阶段采用肝脏左旋显露手法时下腔静脉压力及其他循环指标的变化,探讨该术式的安全性和有效性。方法:选择择期行原位肝移植的手术病人18例,分别记录进腹后左侧旋转肝脏时的下腔静脉压、中心静脉压、平均动脉压等循环指标;测定病人术前至术后肾功能指标。结果:18例肝移植均顺利进行,所有病人术后愈合良好,无明显术后并发症。病人心率和下腔静脉压在肝脏旋转后显著升高(P<0.01)。肾灌注压则在旋肝后显著降低(P0.05),但旋转后2阶段(第2次左旋)出现了显著变化(P0.05)。结论:无论是经典式还是背驮式肝移植术,术中采用肝脏左旋显露手法是一种安全、有效的显露右半肝及肝后下腔静脉的方法。该法可避免传统手法对肝后下腔静脉的机械性损伤,不会引起术中全身血流动力学剧烈波动,对术后肾功能具有保护作用。

Liver left-rotating revelation maneuver and its effects on inferior vena cava in liver transplantation

Objective To investigate the safety and efficiency of liver left-rotating revelation maneuver by observing the pressure of inferior vena cava(IVC) and monitoring other hemodynamic parameters during liver resection stage in liver transplantation.Methods Eighteen patients were subjected to selective orthotopic liver transplantation.The hemodynamic parameters were measured including IVC pressure,central venous pressure and mean arterial pressure during liver left-rotating stage after opening the abdominal cavity.We also respectively recorded preoperative and postoperative serum creatinine,urea nitrogen levels and urine output.Results All the 18 transplantations were successfully preceded.Patients were well recovered without major complications.The heart rate,IVC pressure increased after liver rotation,while the renal perfusion pressure decreased significantly.The IVC and renal perfusion pressure did not change during the first rotating stage,whereas,they changed significantly during the second rotating stage.There was no change for the other hemodynamic parameters.Conclusions Liver left-rotating revelation maneuver is a safe and efficient way for exposing the right lobe and retro-hepatic IVC.It can avoid rupture in retro-hepatic inferior vena cava by conventional method and will not result in drastic fluctuation in systemic hemodynamic.This method can also protect the patients from postoperative renal function injury or failure.