Gurusamy Kurinchi Selvan, Koti Rahul, Pamecha Viniyendra, Davidson Brian R
Department of Surgery, Royal Free Campus, UCL Medical School, 9th Floor, Royal Free Hospital, Pond Street, London, UK, NW3 2QG.
Cochrane Database Syst Rev. 2011 Mar 16(3):CD007712. doi: 10.1002/14651858.CD007712.pub2.
Veno-venous bypass is used to overcome the effects of clamping of the inferior vena cava and portal vein during liver transplanation. The routine use of veno-venous bypass is, however, controversial.
To compare the benefits and harms of veno-venous bypass (irrespective of open or percutaneous technique; heparin-coated or no heparin-coating) versus no veno-venous bypass during liver transplantation. To compare the benefits and harms of the different techniques of veno-venous bypass during liver transplantation.
We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until December 2010.
We included randomised clinical trials comparing veno-venous bypass during liver transplantation (irrespective of language or publication status).
Two authors independently assessed trials for inclusion and independently extracted data. We analysed the data with both the fixed-effect and the random-effects models using RevMan Analysis. For continuous outcomes, we calculated the mean difference (MD) with 95% confidence intervals (CI) based on intention-to-treat or available case analysis. For binary outcomes, we used the Fisher's exact test since none of the comparisons of binary outcomes included more than one trial.
We identified three trials with high risk of bias which compared veno-venous bypass (n = 65) versus no veno-venous bypass (n = 66). None of the trials reported patient or graft survival. There were no significant differences regarding renal failure or blood transfusion requirements between the two groups. None of the trials reported on the morbidity related to veno-venous bypass or the requirement of veno-venous bypass in the control group.We identified one trial with high risk of bias which compared percutaneous (n = 20) versus open technique (n =19) of veno-venous bypass. The patient or graft survival was not reported. There was no difference in veno-venous bypass related morbidity between the two groups. The operating time was significantly shorter in the percutaneous technique group (MD -59 minutes; 95% CI -102 to -16).
AUTHORS' CONCLUSIONS: There is no evidence to support or refute the use of veno-venous bypass in liver transplantation. There is no evidence to prefer any particular technique of veno-venous bypass in liver transplantation.
静脉-静脉转流用于克服肝移植过程中夹闭下腔静脉和门静脉的影响。然而，常规使用静脉-静脉转流存在争议。
比较肝移植期间静脉-静脉转流（无论开放或经皮技术；有无肝素涂层）与无静脉-静脉转流的利弊。比较肝移植期间不同静脉-静脉转流技术的利弊。
我们检索了Cochrane肝胆组对照试验注册库、Cochrane图书馆中的Cochrane对照试验中央注册库（CENTRAL）、MEDLINE、EMBASE和科学引文索引扩展版，检索截至2010年12月。
我们纳入了比较肝移植期间静脉-静脉转流的随机临床试验（无论语言或发表状态）。
两位作者独立评估试验是否纳入并独立提取数据。我们使用RevMan分析软件，采用固定效应模型和随机效应模型对数据进行分析。对于连续性结局，我们基于意向性分析或可用病例分析计算平均差（MD）及95%置信区间（CI）。对于二分结局，由于二分结局的比较均未纳入超过一项试验，我们使用Fisher精确检验。
我们确定了三项偏倚风险高的试验，比较了静脉-静脉转流组（n = 65）与无静脉-静脉转流组（n = 66）。没有试验报告患者或移植物的生存率。两组在肾衰竭或输血需求方面无显著差异。没有试验报告与静脉-静脉转流相关的发病率或对照组中静脉-静脉转流的需求。我们确定了一项偏倚风险高的试验，比较了经皮静脉-静脉转流技术组（n = 20）与开放技术组（n = 19）。未报告患者或移植物的生存率。两组在与静脉-静脉转流相关的发病率方面无差异。经皮技术组的手术时间显著缩短（MD -59分钟；95% CI -102至-16）。
没有证据支持或反驳在肝移植中使用静脉-静脉转流。没有证据表明在肝移植中更倾向于任何特定的静脉-静脉转流技术。
