改良背驮式同种异体肝移植:附14例报告

摘要：目的 总结分析改良背驮式肝移植供肝修整与手术后并发症的关系。方法 回顾性分析我院17例原位背驮式同种异体肝移植中14例改良背驮式肝移植并发症的发生与供肝修整中的关系。14例中行动脉血管变异整形2例，门静脉搭桥吻合1例；14例各韧带修剪后缝合10例，未缝合4例。结果 全组改良背驮式肝移植14例围手术期无死亡；手术成功100％。术后腹腔内出血3例，与供肝修整有关2例。手术后无动脉及门静脉血管并发症，无胆道并发症，无肝脏流出道梗阻。结论 修肝是肝移植中一个重要的环节，修肝质量的好坏，直接关系到术中植肝时手术操作的难度及术后供肝存活的质量；关系到术后并发症的发生。而对于改良背驮式肝移植供肝修整中,肝后下腔静脉的成形至关重要,成形口与供肝静脉出口必相对应,可以有效防止血液涡流的产生,确保流出道通畅,并有效防止血栓的形成。

Modified piggyback liver transplantation:a report of 14cases

Objective To study donor liver repair in modified piggyback liver transplantation and its ~relationship to postoperative complications. Methods The relationship between donor liver repair and ~development of complications of 14 cases of modified piggyback liver transplantation,which among 17 cases of orthotopic piggyback liver allotransplantation performed in our hospital,were analyzed retrospectively.In the 14 cases,abnormal hepatic artery was repaired in 2 cases,portal vein interposition shunt was done in 1 case;~repaired ligaments were sutured in 10 of 14 cases,and not sutured in 4 cases.Results None of the 14 ~patients died in the perioperative period. The success rate of the operation was 100%. 3 patients had ~intra-abdominal bleeding,postoperatively,and in 2 cases the bleeding was related to donor liver repair. ~Postoperatively ,there was no thrombosis of hepatic artery or portal vein, and no bile duct necrosis, no hepatic outflow tract occlusion. Conclusions Donor liver repair is an important procedure in liver tramsplantation.The quality of donor liver repair is directly related to the difficulty of operative technique during liver ~transplantation ,and to the development of postoperative complications.In donor liver repair during piggyback liver transplantation,reconstruction of the retrohepatic vera cava is very important.The constructed stoma must be compatible with the donor hepatic vein outflow stoma and be able to effectively prevent the formation of eddy blood flow,ensure patency of the outflow tract and effectively prevent thrombus formation.