改进的二袖套法大鼠原位肝移植术

目的 制作改进的二袖套法大鼠原位肝移植模型。方法 在原二袖套法的基础上，于受者门静脉和肝下下腔静脉吻合前放出部分高凝血液，而肝上下腔静脉的吻合是在供肝膈肌环与受者肝上下腔静脉血管壁之间进行。结果 改进的二袖套法吻合效果确实可靠，手术成功率达96．7％，动物的1周存活率为90．0％。结论 该模型稳定可靠，可用于大鼠肝移植方面的研究。     

改良二袖套法大鼠原位肝移植180例

目的改进二袖套法大鼠原位肝移植方法,建立稳定的大鼠肝移植模型。方法采用改良Kamada二袖套法进行大鼠原位肝移植180例,观察手术成功率、手术时间、免疫病理改变和术中、术后并发症等。结果总手术成功率85.6%,供者手术时间(40.0±3.8)min,修肝时间(14.3±2.1)min,受者手术时间(48.0±4.2)min,无肝期(22.0±2.3)min。SD-Wistar大鼠肝移植后出现免疫排斥病理改变。常见并发症有麻醉意外、气胸、失血性休克、下腔静脉空气栓塞、血栓形成或胆道梗阻等。结论改良Kamada二袖套法可提高手术成功率,减少并发症。SD-Wistar大鼠肝移植为高排斥组合,可作为肝移植免疫耐受研究的模型。     

二袖套法大鼠原位肝移植手术方法的改进

目的：通过对二袖套法大鼠原位肝移植手术方法进行改进，提高大鼠肝移植动物模型的稳定性。方法：采用改良的二袖套法施行大鼠原位肝移植动物实验110例，观察术后并发症及24h、一周存活率。结果：袖套准备时间5—9min，24h存活率91．8％(101／110)，一周存活率为87．3％(96／110)。结论:改进的大鼠原位肝移植术操作简便，手术成功率高，重复性好，提高了大鼠肝移植动物模型的稳定性。     

提高二袖套法大鼠原位肝移植成功率的手术技巧

目的　探讨二袖套法大鼠原位肝移植的手术技巧。方法　在Kamada“二袖套法”基础上进行改良。获取供肝前阻断肝门血供 10min ,再灌注 10min ;分别经腹主动脉和门静脉对肝脏进行双重灌注 ;门静脉和肝下下腔静脉用袖套法吻合 ,肝上下腔静脉用缝合法吻合 ,胆总管采用单管内支架胆管端端吻合法。结果　共施行大鼠原位肝移植 12 0次 ,手术成功率为 90 .8%。平均无肝期为 ( 2 1.0± 3.5 )min ,受体总手术时间为 ( 4 6 .0± 4 .5 )min ,1周生存率为 87.2 %。结论　良好的手术野暴露 ,娴熟的显微外科技术 ,精细的手术操作和配合有助于缩短受体无肝期及总手术时间和提高受体生存率     

二袖套法建立大鼠原位肝移植模型的初步体会

作者1997年11月至1998年7月共行大鼠原位肝移植实验76次,将Kamada及孙君泓二袖套法进行了改进,现将手术体会报告如下。1　材料与方法1　SD封闭群大鼠152只(由中山医科大学动物中心提供),雄性,体重250～320g。2　用内径1.2mm、外径1.8mm的聚乙烯管作门静脉套管,内径2.0mm、外径3.0mm的聚乙烯管作肝上及肝下下腔静脉套管。用一次性硬膜外麻醉导管作胆总管插管。3　手术方法:按Kamada等[1]及孙君泓等[2]二袖套法略作改进。要点是:大鼠术前不禁食水,乙醚吸入麻醉,清洁手术。术前10分钟肌注阿托品0.05mg。腹正中切口进腹,供体胆总管插管、阴茎…     

三袖套法大鼠原位肝移植模型的体会

作者通过１２０次大鼠原位肝移植实验对Ｍｉａｔａ三袖套法进行了改进，现将手术体会报告如下。材料与方法１．ＳＤ封闭群杂交大鼠１６０只（由解放军总医院实验动物中心提供），Ｗｉｓｔａｒ封闭群杂交大鼠１００只（由军事医学科学院实验动物中心提供），体重２２０一２９０ｇ，雌雄不限。２。选用内径２．５５ｒｕｍ的聚乙烯导管为肝上和肝下下腔静脉套管；内径１９１ｒｕｍ的聚乙烯管为门静脉套管；用一次性硬膜外麻醉导管制作胆管插管。３．手术方法：（）供受体均采用乙醚吸人麻醉，清洁手术，术前１２小时禁食。（）手术方法：参照Ｍ…     

受者肝分步切除的三袖套法大鼠原位肝移植术

目的 制作改进的三袖套法大鼠原位肝移植模型。方法 供肝置入时先不切除受者肝,而是在吻合血管的过程中分步切除受者肝。结果 该术式在大缩短了无肝期,平均仅１１．８分钟,进一步简化了手术操作,手术成功率２４／２６。结论 该模型可用于大鼠肝移植的研究。     

改良三袖套法大鼠原位肝移植

改良三袖套法大鼠原位肝移植张绍庚方石岗吴孟超陈汉杨甲梅谈景旺本实验参照Ｈａｒｉｈａｒａ〔１〕三袖套法吻合肝上、肝下下腔静脉和门静脉（以下简称ＳＶＣ、ＩＶＣ和ＰＶ），并进行了部分改进，旨在简化操作和减少损伤。具有血流通畅、无肝期短、手术成功率高等优点。...     

改进的三袖套法大鼠原位肝移植

目的:制作改进的三袖套法大鼠肝移植模型.方法:参照Kamada、孙君泓等介绍的方法,着重对麻醉方法、肝上下腔静脉袖套制作和吻合以及受体去肝顺序等做了进一步的改进.结果:手术时间供体为31~40 min,平均35 min;受体为37~45 min,平均41 min;无肝期最短的8 min,平均12.8 min.24 h手术成功率为85%,1 w存活率为63.3%.结论:该模型术式简化了手术操作,缩短了无肝期,可用于大鼠肝移植的研究.     

Magnetic ring anastomosis of suprahepatic vena cava: novel technique for liver transplantation in rat

To improve the technique of suprahepatic vena cava (SHVC) reconstruction in rat OLT, novel magnetic rings were designed and manufactured to facilitate reconstruction of SHVC and shorten the anhepatic time. One‐hundred and twenty adult male Wistar rats were randomly divided into two groups: rings group (n = 30), using magnetic rings for SHVC reconstruction; suture group (n = 30), 7/0 prolene suture was used for SHVC running anastomosis as control. Cuff techniques were used for portal vein and infrahepatic vena cava reconstruction as Kamada and Calne described. The bile duct was reconnected with a stent. The hepatic re‐arterialization was omitted. In the rings group, the SHVC reconstruction took 0.91 ± 0.24 (mean ± SD) min; the anhepatic phase and the recipient operation time were 5.63 ± 0.65 min and 36.02 ± 8.02 min, respectively. In suture group, the anastomotic time of SHVC was 10.40 ± 2.11 min; the anhepatic phase and the recipient operation time were 17.76 ± 2.51 and 49.38 ± 12.06 min, respectively, and there was statistically significant difference between the two groups. The ALT levels reached peak at 24 h post‐OLT (186.2 ± 32.5 IU/l) and restored to normal level at 96 h gradually. In the rings group, 29 of 30 rats survived at day 7 and 28 of 30 rats survived at day 30. In contrast, only 25 of 30 recipients in suture group remained alive at day 7 and 22 of 30 remained alive at day 30 (P < 0.05). Better anastomotic healing was founded in rings group by pathology and scanning electron microscope. The magnetic rings technique provides a novel, simple method for SHVC reconstruction of OLT in rat. It significantly shortens anhepatic phase, while the success rate of the operation is satisfactory.     

Liver transplantation with preservation of the inferior vena cava in case of symptomatic adult polycystic disease

Adult polycystic liver disease (APLD) is a rare disorder of the liver parenchyma, the treatment of which is still controversial. Conservative surgery may have a significant morbidity and is often ineffective in the long run. Liver replacement may be indicated in case of incapacitating hepatomegaly. Patients (one male, five females) undergoing liver transplantation for symptomatic APLD is presented in this study. The particular nature of this series is the fact that successful transplantation was performed in all cases with preservation of the recipient's inferior vena cava and without use of veno-venous bypass despite massive hepatomegaly and previous extensive liver surgery (in three cases). There was minimal morbidity and no mortality. All patients have excellent quality of life with a median follow-up of 41 months (range: 12-58) as testified by a median Karnofsky score of 90% (range: 80-100%).     

Advantages of inferior vena caval flow preservation in combined transplantation of the liver and heart

Only a few cases of combined liver and heart transplantation have been reported in the literature, and no standard surgical procedure has yet been established. We report the successful transplantation of both liver and heart in a 28-year-old patient suffering from homozygous beta-thalassemia. We used Belghiti's technique of inferior vena caval flow preservation for liver transplantation, which avoids inferior vena cava occlusion by a side-to-side caval anastomosis. Applied to combined liver and heart transplantation, preservation of caval flow during liver transplantation may allow early discontinuation of cardiopulmonary bypass and, thus, minimize the general consequences of prolonged bypass. Received: 21 May 1996 Received after revision: 11 September 1996 Accepted: 23 September 1996     

Replacement of the retrohepatic vena cava in segmental liver transplantation

Reduced grafts represent an important technical development in paediatric liver transplantation. The use of a left lateral segment graft has required preservation of the native inferior vena cava to “piggy-back” the graft onto it. We report four children who underwent left lateral segment transplantation with caval replacement using the donor iliac vein because the native retrohepatic inferior vena cava was small, friable or difficult to preserve. There were no caval or hepatic vein complications post-transplant and the donor iliac vein proved to be a satisfactory interpositional graft. The technique offers the advantages of a wider retrohepatic cava avoiding venous outflow or caval obstruction, provides good tissue to suture and is well suited for the triangulation technique of the left hepatic vein. Received: 24 January 1997 Received after revision: 20 June 1997 Accepted: 30 June 1997     

Superior vena cava obstruction and liver transplantation in a child

We report a case of superior vena cava obstruction in a child, which was probably secondary to long-term central venous cannulation. The obstruction was asymptomatic preoperatively, but became evident during liver transplantation, and complicated the intraoperative management. There is one other case report of this occurring in an adult in similar circumstances, and we believe that ours is the first report of such a presentation in the paediatric age group.     

Liver transplantation in a patient with complex anomaly of the inferior vena cava

Background

After the introduction of noninvasive imaging exams, congenital anomalies of the inferior vena cava (IVC) have become more commonly recognized. We report the first successful orthotopic liver transplantation (OLT) performed in an asymptomatic adult with complex IVC anomaly: duplication of the infrarenal IVC, azygos continuation of the IVC, agenesia of the hepatic portion of the IVC and presence of several anomalous veins communicating the common iliac vein and the IVC of one side with the contralateral side.

Methods

This complex anomaly was diagnosed with a venous abdominal angio CT.

Results

At liver transplantation, the short suprahepatic portion of the IVC was identified and clamped. The right, middle, and left hepatic veins were sectioned and joined in a single, wide cuff, using venoplasty. This single orifice was anastomosed to the suprahepatic IVC of the new liver. No venovenous bypass was employed. The patient had an uneventful postoperative course. A post transplantation venous abdominal angio CT showed normal blood flow at the anastomosis of the hepatic veins of the receptor and the IVC of the new liver.

Conclusions

This report is important to alert liver transplant teams of the possibility of complex IVC in asymptomatic adult individuals. Identification of these anatomical anomalies is vital to reduce the risk of serious hemorrhage and other operative complications during OLT.     

A new technique of hepatic vein reconstruction in partial liver transplantation

The shortage of pediatric donor livers has stimulated the development of advanced surgical approaches such as partial liver transplantation, which produces the same results as whole organ replacement. Differences in body weight between donor and recipient of more than four times, however, usually necessitate extended reduction hepatectomy and modified ways of performing vascular reconstruction. Therefore, following ex vivo trisegmentectomy, a new technique of hepatic venous drainage was developed with an end-to-side anastomosis of the left donor hepatic vein to the preserved recipient inferior vena cava. This operative technique was applied to four children, one of whom had a retransplantation performed in exactly the same fashion. There were no specific complications related to this particular surgical technique. From our preliminary experience we conclude that reduced-size liver transplantation can be safely performed with the described type of hepatic vein reconstruction, especially when large donor organs have to be used for small children.     

Feasibility of hanging maneuvers in orthotopic liver transplantation with inferior vena cava preservation and in liver surgery

Background/Purpose The aim of this work was to study the feasibility and complication rates of liver hanging maneuvers: the Belghiti liver hanging maneuver (BLHM) in liver resection and the modified liver hanging maneuver (MLHM) in orthotopic liver transplantation (OLT) with inferior vena cava (IVC) preservation.Methods From January 2001 to August 2003, BLHM was planned in 26 consecutive right hepatectomies and MLHM in 28 consecutive OLTs with IVC preservation.Results BLHM was performed in 24/26 patients (92%). In the 2 remaining patients, chronic biliary infection (n = 1) and intraparenchymal hemorrhagic hepatocellular carcinoma (n = 1) did not allow BLHM to be achieved. Bleeding during the BLHM procedure occurred in 1 patient (4%), with no need for interruption. MLHM was performed in all 28 patients, and in none of them was bleeding observed during the maneuver.Conclusions BLHM and MLHM are important technical refinements with several advantages. Feasibility rates were 92% and 100%, respectively. Bleeding risk remained low (4%) for BLHM and was 0% for MLHM. The rate of BLHM failure suggests that the feasibility rate may be higher in normal liver parenchyma.     

Venous complications after orthotopic liver transplantation

Complications involving the portal vein or the vena cava, are rare after orthotopic liver transplantation. We report on the incidence and treatment of venous complications following 1000 orthotopic liver transplantations in 911 patients. Twenty-six of the adult patients (2.7%) suffered from portal complications after transplantation, whereas complications of the vena cava were observed in only 17 patients (1.8%). Technical problems or recurrence of the underlying disease (e.g. Budd-Chiari syndrome) accounted for the majority of complications of the vena cava, whereas alteration of the vessel wall or splenectomy during transplantation could be identified as important risk factors for portal vein complications. In patients undergoing modification of the standard end-to-end veno-venous anastomosis of the portal vein due to pathological changes of the vessel wall, complications occurred in 8.3%, whereas only 2.4% of patients who received a standard anastomosis of the portal vein experienced complications of the portal vein. Furthermore, splenectomy during transplantation was also associated with an increased incidence of portal vein complications (10.5 vs. 2.2% in patients without splenectomy). Treatment was dependent on the signs and symptoms of the patients, and varied considerably between patients with portal vein complications and patients suffering from complications of the vena cava. Complications of the vena cava led to retransplantation in about one-third of the patients, whereas in patients with occlusion of the portal vein, retransplantation was necessary in only 15%, and more than half of the patients suffering from portal vein complications did not require any treatment at all. Usually, treatment of patients with portal vein complications only became necessary when additional complications such as arterial occlusion or bile duct injuries occurred.