Hesse U J, Berrevoet F, Troisi R, Mortier E, Decruyenaere J, Pattyn P, de Hemptinne B
Chirurgische Klinik, Universitätsklinik Gent, Belgien.
Chirurg. 1999 Feb;70(2):174-7; discussion 178. doi: 10.1007/s001040050065.
The experience with laterolateral cavocavostomy for hepatovenous reconstruction in liver transplantation is reviewed with and without the use of a temporary portocaval shunt. A total of 65 liver transplantations were analyzed. In 49 transplantations a laterolateral cavocaval anastomosis was performed (group I). In group II (n = 16) the same technique was used after a temporary portal caval shunt was constructed. Mean arterial pressure (mmHg): group I 128 +/- 34; group II 109 +/- 32. Cardiac output (l/min) decrease during the anhepatic phase was 2.3 +/- 1.9 and 1.2 +/- 1.5, respectively (P < 0.05). The peroperative blood loss measured as the number of packed cells transfused was 16.4 +/- 15.8 versus 1.2 +/- 2.3 (P < 0.04) and fresh frozen plasma 19.0 +/- 14.7 versus 3.7 +/- 4.0 (P < 0.02). Course on ICU (days), liver function tests, renal function and the need for reoperation because of bleeding were not statistically significantly different between the groups. One-year patient survival was 82.7 and 85.7%, respectively. In conclusion, we found that despite preservation of the caval flow during hepatectomy, the additional use of a temporary portocaval shunt was advantageous with regard to peroperative hemorrhage and hemodynamic stability and can potentially facilitate implantation of the liver graft.
回顾了在肝移植中使用和不使用临时门腔分流术进行肝静脉重建的外侧腔静脉吻合术的经验。共分析了65例肝移植病例。49例移植手术中进行了外侧腔静脉吻合术（第一组）。在第二组（n = 16）中，在构建临时门腔分流术后使用了相同的技术。平均动脉压（mmHg）：第一组128±34；第二组109±32。无肝期心输出量（l/min）的下降分别为2.3±1.9和1.2±1.5（P < 0.05）。以输注的浓缩红细胞数量衡量的术中失血量为16.4±15.8对1.2±2.3（P < 0.04），新鲜冰冻血浆为19.0±14.7对3.7±4.0（P < 0.02）。两组在重症监护病房的住院天数、肝功能检查、肾功能以及因出血需要再次手术方面无统计学显著差异。患者一年生存率分别为82.7%和85.7%。总之，我们发现尽管在肝切除术中保留了腔静脉血流，但额外使用临时门腔分流术在术中出血和血流动力学稳定性方面具有优势，并且可能有助于肝移植的植入。
