背驮式技术在成人原位肝移植中的应用：单中心 1067 例肝移植分析。
Piggyback technique in adult orthotopic liver transplantation: an analysis of 1067 liver transplants at a single center.
机构信息
Division of Transplantation, Department of Surgery, University of Miami/Jackson Memorial Medical Center, Miami, FL, USA.
出版信息
HPB (Oxford). 2006;8(3):182-8. doi: 10.1080/13651820500542135.
BACKGROUND
Orthotopic liver transplantation (OLT) in adult patients has traditionally been performed using conventional caval reconstruction technique (CV) with veno-venous bypass. Recently, the piggyback technique (PB) without veno-venous bypass has begun to be widely used. The aim of this study was to assess the effect of routine use of PB on OLTs in adult patients.
PATIENTS AND METHODS
A retrospective analysis was undertaken of 1067 orthotopic cadaveric whole liver transplantations in adult patients treated between June 1994 and July 2001. PB was used as the routine procedure. Patient demographics, factors including cold ischemia time (CIT), warm ischemia time (WIT), operative time, transfusions, blood loss, and postoperative results were assessed. The effects of clinical factors on graft survival were assessed by univariate and multivariate analyses.In all, 918 transplantations (86%) were performed with PB. Blood transfusion, WIT, and usage of veno-venous bypass were less with PB. Seventy-five (8.3%) cases with PB had refractory ascites following OLT (p=NS). Five venous outflow stenosis cases (0.54%) with PB were noted (p=NS). The liver and renal function during the postoperative periods was similar. Overall 1-, 3-, and 5-year patient survival rates were 85%, 78%, and 72% with PB. Univariate analysis showed that cava reconstruction method, CIT, WIT, amount of transfusion, length of hospital stay, donor age, and tumor presence were significant factors influencing graft survival. Multivariate analysis further reinforced the fact that CIT, donor age, amount of transfusion, and hospital stay were prognostic factors for graft survival.
CONCLUSIONS
PB can be performed safely in the majority of adult OLTs. Results of OLT with PB are as same as for CV. Liver function, renal function, morbidity, mortality, and patient and graft survival are similar to CV. However, amount of transfusion, WIT, and use of veno-venous bypass are less with PB.
背景
成人原位肝移植（OLT）传统上采用常规腔静脉重建技术（CV）联合静脉-静脉转流。近来，无静脉-静脉转流的背驮式技术（PB）开始广泛应用。本研究旨在评估在成人患者中行 PB 常规应用对 OLT 的影响。
患者和方法
回顾性分析 1994 年 6 月至 2001 年 7 月期间接受的 1067 例成人尸体全肝移植患者资料。采用 PB 作为常规术式。评估患者的人口统计学特征、冷缺血时间（CIT）、热缺血时间（WIT）、手术时间、输血、出血及术后结果等因素。采用单因素和多因素分析评估临床因素对移植物存活率的影响。共行 918 例 PB 手术（86%）。与 CV 相比，PB 输血、WIT 及静脉-静脉转流使用率更低。75 例 PB 术后发生难治性腹水（p=NS）。5 例 PB 发生静脉流出道狭窄（0.54%）（p=NS）。术后肝肾功能相似。PB 患者 1、3、5 年总生存率分别为 85%、78%和 72%。单因素分析显示腔静脉重建方法、CIT、WIT、输血量、住院时间、供者年龄和肿瘤存在是影响移植物存活率的显著因素。多因素分析进一步证实 CIT、供者年龄、输血量和住院时间是移植物存活率的预后因素。
结论
在大多数成人 OLT 中，PB 可安全施行。PB 与 CV 相比，OLT 结果相同。肝功能、肾功能、发病率、死亡率以及患者和移植物存活率与 CV 相似。然而，PB 输血、WIT 及静脉-静脉转流使用率更低。
Zotero 插件