Sato M, Nashan B, Grosse H, Barthels M, Pichlmayr R
Klinik für Abdominal und Transplantationschirurgie, Medizinische Hochschule Hannover, Federal Republic of Germany.
Jpn J Surg. 1991 Sep;21(5):561-5. doi: 10.1007/BF02470995.
Ex situ hepatic surgery, in which a diseased liver is resected from outside the body, was first reported in 1988. This study investigates the hemostatic changes occurring during such surgery in two cases. During the anhepatic period of more than 5 hours, veno-venous bypass without heparin was performed. The tests included platelet count, prothrombin activity (PT), partial thromboplastin time (PTT), fibrinogen (Fbg), factor II (F.II), factor V (F.V), and thromboelastography (TEG). Three to 4 hours after entering the anhepatic phase, marked fibrinolysis and a fall in the values of PT, Fbg and F.V. were observed. Every parameter temporarily deteriorated immediately after revascularization of the graft, however, all returned to almost normal values within 1-2 hours after hepatic reperfusion except for F.V and platelets. In conclusion, the coagulopathy during ex situ hepatic surgery is caused by the marked fibrinolysis and depletion of hemostatic factors which develop 3-4 hours after the onset of the anhepatic phase.
体外肝脏手术是指将病变肝脏从体外切除，首例报告于1988年。本研究调查了两例此类手术过程中发生的止血变化。在超过5小时的无肝期，进行了无肝素的静脉-静脉转流。检测项目包括血小板计数、凝血酶原活性（PT）、活化部分凝血活酶时间（PTT）、纤维蛋白原（Fbg）、因子II（F.II）、因子V（F.V）和血栓弹力图（TEG）。进入无肝期3至4小时后，观察到明显的纤溶以及PT、Fbg和F.V值下降。移植肝血管再通后，各项参数立即暂时恶化，然而，除F.V和血小板外，肝再灌注后1至2小时内所有参数均恢复至几乎正常水平。总之，体外肝脏手术期间的凝血病是由无肝期开始3至4小时后出现的明显纤溶和止血因子消耗所致。
