Department of Anesthesiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
Transpl Int. 2010 Dec;23(12):1247-58. doi: 10.1111/j.1432-2277.2010.01144.x. Epub 2010 Aug 16.
Use of piggyback technique (PB) and elimination of venovenous bypass (VVB) have been advocated in adult liver transplantation (LT). However, individual contribution of these two modifications on clinical outcomes has not been fully investigated. We performed a retrospective review of 426 LTs within a 3-year period, when three different surgical techniques were employed per the surgeons' preference: retrohepatic caval resection with VVB (RCR+VVB) in 104 patients, PB with VVB (PB+VVB) in 148, and PB without VVB (PB-Only) in 174. The primary outcomes were intraoperative blood transfusion and the patient and graft survivals. Demographic profiles were similar, except younger recipient age in RCR+VVB and fewer number of grafts with cold ischemic time over 16 h in PB-Only. PB-Only required lesser intraoperative red blood cells (P=0.006), fresh frozen plasma (P=0.005), and cell saver return (P=0.007); had less incidence of acute renal failure (P=0.001), better patient survival (P=0.039), and graft survival (P=0.003). The benefits of PB+VVB were only found in shortened total surgical time (P=0.0001) and warm ischemic time (P=0.0001), and less incidence of acute renal failure (P=0.001) than RCR+VVB. PB-Only method seemed to provide the best clinical outcome. The benefit of PB was not fully achieved when it was used with VVB.
在成人肝移植（LT）中，提倡使用背驮式技术（PB）和消除静脉-静脉旁路（VVB）。然而，这两种改进方法对临床结果的个体贡献尚未得到充分研究。我们对 3 年内进行的 426 例 LT 进行了回顾性分析，当时根据外科医生的偏好采用了三种不同的手术技术：带 VVB 的肝后下腔静脉切除术（RCR+VVB）104 例，带 VVB 的 PB（PB+VVB）148 例，不带 VVB 的 PB（PB-Only）174 例。主要结果是术中输血以及患者和移植物存活率。除了 RCR+VVB 中受体年龄较小和 PB-Only 中冷缺血时间超过 16 小时的移植物数量较少外，人口统计学特征相似。PB-Only 需要较少的术中红细胞（P=0.006）、新鲜冷冻血浆（P=0.005）和细胞保存器返回（P=0.007）；急性肾衰竭（P=0.001）、患者存活率（P=0.039）和移植物存活率（P=0.003）均更好。只有 PB+VVB 与 RCR+VVB 相比，总手术时间（P=0.0001）和热缺血时间（P=0.0001）缩短，急性肾衰竭（P=0.001）发生率降低，具有优势。PB-Only 方法似乎提供了最佳的临床结果。当与 VVB 一起使用时，PB 的优势并未完全实现。
