Department of Anesthesiology and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria.
Transplantation. 2012 Jul 27;94(2):192-6. doi: 10.1097/TP.0b013e31825475c2.
Hemodynamic monitoring using transesophageal echocardiography (TEE) in patients with signs of portal hypertension undergoing orthotopic liver transplantation (OLT) carries potential risk of esophageal and gastric variceal hemorrhage. The aim of our retrospective analysis was to evaluate the safety of intraoperative TEE monitoring during OLT in patients with esophagogastric varices.
A retrospective analysis of 396 liver transplant recipients was performed at the Medical University of Vienna monitored by TEE during OLT between 2003 and 2010.
Varices were documented by esophagogastroduodenoscopy in 287 (72.5%) of 396 analyzed patients: 130 (32.8%) varices grade I (<5 mm under insufflation) and 157 (39.6%) varices grade II (>5 mm under insufflation). Red spot signs were identified in 40 patients (10.1%). Most varices (82.2%) were documented in the esophagus, 4.2% in the stomach, and 13.6% in both (esophagus and stomach). Only one major bleeding occurred, and it was only in a case of one patient with an esophageal varix, which was treated with a balloon tamponade during OLT. Although patients with varices demonstrated a significantly longer prothrombin time and lower platelet count, there was no significant difference in the requirement for blood products among patients with and without varices.
TEE is a relatively safe method for monitoring cardiac performance with a low incidence of major hemorrhagic complications in patients with documented esophagogastric varices undergoing OLT.
在接受原位肝移植（OLT）的门脉高压体征患者中，使用经食管超声心动图（TEE）进行血流动力学监测具有食管和胃静脉曲张出血的潜在风险。我们回顾性分析的目的是评估在伴有食管胃静脉曲张的 OLT 期间进行术中 TEE 监测的安全性。
对 2003 年至 2010 年期间在维也纳医科大学接受 OLT 监测的 396 例肝移植受者进行了回顾性分析。
通过食管胃十二指肠镜检查在 396 例分析患者中的 287 例（72.5%）记录到静脉曲张：130 例（<充气下 5 毫米）静脉曲张 I 级和 157 例（>充气下 5 毫米）静脉曲张 II 级。在 40 例患者（10.1%）中识别到红点征。大多数静脉曲张（82.2%）位于食管，4.2%位于胃，13.6%位于食管和胃（食管和胃）。仅发生 1 例大出血，且仅发生在 1 例食管静脉曲张患者中，在 OLT 期间用气囊填塞治疗。尽管有静脉曲张的患者凝血酶原时间明显延长，血小板计数较低，但有静脉曲张和无静脉曲张的患者在血液制品需求方面无显著差异。
TEE 是一种监测心脏功能的相对安全方法，在接受 OLT 并伴有食管胃静脉曲张的患者中，其主要出血并发症的发生率较低。
