Pararas Nikolaos, Levi David, Selvaggi Gennaro, Moon Jang, Nishida Seigo, Tryphonopoulos Panagiotis, Island Eddie, Tzakis Andreas
Division of Transplantation, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Ann Surg. 2009 Aug;250(2):273-6. doi: 10.1097/SLA.0b013e3181b17161.
Classic dissection of the hilar structures during the hepatectomy portion of the liver transplant procedure is sometimes extremely difficult and even dangerous. In such cases, clamping of the hepatic hilar structures en mass can be an effective alternative. In this study, we describe our center's experience with this technique.
This is a retrospective analysis of all patients who received a liver allograft using this technique at our center, between September 1996 and September 2007 (n = 150). Postoperative follow-up was through November 30, 2007.
One hundred fifty patients underwent 155 liver transplants using hilar mass clamping. These cases represent 7% of the total number of cases performed at our center during that time interval (n = 2219). This included 93 male and 57 female patients, 18 children and 132 adults. There were 103 primary liver transplants, 52 retransplants. Three of the primary transplants were combined liver/kidney transplants. In 7 cases (4.5%), portacaval hemitransposition was performed to establish portal flow.The decision to perform the hepatectomy with mass clamping of the hilar structures was an intraoperative judgment made when severe vascular adhesions and scarring of the hilum (n = 137) or extensive hilar varices (n = 18) were encountered. The hilar pathology was often associated with hepatic artery (n = 15) or portal vein thrombosis (n = 14).Mean surgical time was 11.33 +/- 0.28 hours. Average blood replacement was 26.27 +/- 2.05 units of packed red blood cells. One patient died intraoperatively (0.64%) while perioperative (30 day) mortality was 6.4%. Venovenous by pass was used in 1 patient (0.64%).One and 5 year patient survival was 75.3% and 61.2%, respectively. One and 5 year graft survival was 73.7% and 48.2%, respectively. There was no patient mortality, graft loss, or technical complications that could be attributed to the mass clamp technique.
Mass clamping of the hepatic hilum can be an effective alternative to classic hilar dissection in cases when the latter is difficult or impossible.
在肝移植手术的肝切除部分，对肝门结构进行传统的解剖有时极其困难甚至危险。在这种情况下，对肝门结构进行整体钳夹可能是一种有效的替代方法。在本研究中，我们描述了我们中心应用该技术的经验。
这是一项对1996年9月至2007年9月期间在我们中心接受同种异体肝移植并使用该技术的所有患者的回顾性分析（n = 150）。术后随访至2007年11月30日。
150例患者接受了155次使用肝门整体钳夹的肝移植手术。这些病例占该时间段内在我们中心进行的病例总数的7%（n = 2219）。其中包括93例男性和57例女性患者，18例儿童和132例成人。有103例初次肝移植，52例再次移植。其中3例初次移植为肝/肾联合移植。在7例（4.5%）患者中，进行了门腔静脉半转位以建立门静脉血流。决定采用肝门结构整体钳夹进行肝切除是在术中遇到严重的血管粘连和肝门瘢痕形成（n = 137）或广泛的肝门静脉曲张（n = 18）时做出的判断。肝门病变常与肝动脉（n = 15）或门静脉血栓形成（n = 14）相关。平均手术时间为11.33±0.28小时。平均输血量为26.27±2.05单位浓缩红细胞。1例患者术中死亡（0.64%），围手术期（30天）死亡率为6.4%。1例患者（0.64%）使用了静脉-静脉转流。1年和5年患者生存率分别为75.3%和61.2%。1年和5年移植物生存率分别为73.7%和48.2%。没有患者死亡、移植物丢失或技术并发症可归因于整体钳夹技术。
在传统肝门解剖困难或无法进行时，肝门整体钳夹可作为一种有效的替代方法。
