临时性腔门静脉半转位术在门静脉栓塞患者肝移植术中作用

摘要：目的:探讨临时性腔门静脉半转位术(TCPHT)在门静脉栓塞(PVT)患者经典非转流肝移植(OLT)中的应用价值。 方法:总结5年间32例肝移植术前合并Yerdel Ⅲ~Ⅳ级PVT患者中11例施行TCPHT术（TCPHT组）、21例未施行TCPHT术(对照组)者的临床资料。比较两组患者的手术时间和无肝期时间、再灌注期平均动脉压（MAP）、中心静脉压（CVP）和肺动脉楔压（PAWP）等循环参数以及无肝期尿量、再灌注期尿量等肾功能参数。结果:TCPHT组和对照组手术时间和无肝期时间均无显著性差异（P>0.05）。两组比较，虽然术后第1天肾功能指标差异无显著性，但TCPHT组无肝期尿量明显增加，两者分别为（64.09±20.79）mL和（25.90±12.17）mL （P=0.033)；再灌注期尿量分别是(1254.56±311.81) mL和（800.00±375.83）mL,（P=0.002)，且TCPHT组术后需要透析的病例数较对照组显著减少(P<0.05)。体循环血流动力学显示，TCPHT组较对照组开放后具有更加稳定的MAP，两组分别为(76.45±12.67)mmHg和（66.52±7.48）mmHg（P=0.032)；CVP分别为（13.96±1.74）cm H2O和（12.44±1.07）cm H2O （P=0.005)；PAWP分别为（24.04±1.48）mmHg和（22.81±1.23）mmHg （P=0.018)。结论:TCPHT能有效地稳定门静脉栓塞患者肝移植再灌注期血流动力学，减少术后肾功能不全的发生率，而不增加手术难度。

The role of temporary cavoportal hemitransposition during liver transplantation in patients with portal vein thrombus

Abstract:Objective:To investigate the application of temporary cavoportal hemitransposition (TCPHT) during conventional orthotopic liver transplant (OLT) in patients with portal vein thrombus (PVT) . Methods :A group of eleven patients who underwent TCPHT (TCPHT group) was compared with another group of twenty-one patients without TCPHT (control group) among thirty-two adult OLT recipients with PVT of Yerdel′ Ⅲor Ⅳ degree during the recent 5 years. Duration of operation and anhepatic phase, and urinary production in anhepatic and reperfusion phase, and parameters of systemic hemodynamics such as mean artrial blood pressure(MAP), central venous pressure(CVP) and pulmonary arterial wedge pressure(PAWP) were comparatively analysed by case-control study.Results:No difference in surgical duration and anhepatic time (P>0.05) was found between two groups. There was no significant difference of renal function parameters between the 2 groups at the first day post-transplantation, but the TCPHT group had an improved mean urinary output during anhepatic phase ［(64.09±20.79)mL vs (25.90±12.17)mL, P=0.033］; overall urinary production after reperfusion of TCPHT group and controls was (1 254.56±311.81)mL and (800.00±375.83)mL respectively (P=0.002); cases requiring hemodialysis in TCPHT group decreased markedly (P=0.032). Systemic hemodynamics between TCHHT and control group showed MAP after reperfusion (76.45±12.67) mmHg vs (66.52±7.48)mmHg (P=0.032), CVP(13.96±1.74)cm H2O vs (12.44±1.07)cm H2O(P=0.005), and PAWP(24.04±1.48) mmHg vs (22.81±1.23)mmHg (P=0.018), respectively.Conclusions:The results suggests that TCPHT is a reliable surgical technique in OLT patients with HVT. This surgical strategy could effectively stabilize systemic hemodynamics and decrease the rate of postoperative renal failure,and without increase in the difficulty of operation.