Lübbe N, Bornscheuer A, Pichlmayr R, Grosse H, Kirchner E
Zentrum Anästhesiologie, Medizinischen Hochschule Hannover.
Anasth Intensivther Notfallmed. 1990 Apr;25(2):146-51.
In a 40-year old patient multiple liver tumours that were otherwise regarded as irresectable were removed in an ex situ operation--according to the authors' knowledge for the first time in a human. After protective perfusion with a hypothermic HTK solution hepatectomy was performed. After extirpation of the tumours ex situ, the residual liver was re-implanted. The total operation time was 13 h 50 min, the anhepatic period lasted for 6 h 9 min. During the anhepatic period a venous bypass shunted the blood from the a femoral and the portal vein to an axillary vein. Considerable blood loss was balanced by the transfusion of 26 units of banked blood. Severe disturbances of blood coagulation could be avoided by early substitution with fresh frozen plasma, platelets and fresh blood. The long anhepatic phase caused an acidosis that required the application of 330 mVal NaHCC3. In the discussion the necessity for an aggressive intraoperative monitoring of haemodynamic and laboratory parameters is emphasized.
在一名40岁患者中，原本被认为无法切除的多个肝脏肿瘤通过异位手术被切除——据作者所知，这在人类中尚属首次。在用低温HTK溶液进行保护性灌注后实施了肝切除术。在异位切除肿瘤后，将残余肝脏重新植入。手术总时长为13小时50分钟，无肝期持续6小时9分钟。在无肝期，一条静脉旁路将来自股静脉和门静脉的血液分流至腋静脉。通过输注26单位库存血平衡了大量失血。通过早期输注新鲜冷冻血浆、血小板和新鲜血液避免了严重的凝血功能障碍。较长的无肝期导致酸中毒，需要应用330毫当量的碳酸氢钠。在讨论中强调了术中积极监测血流动力学和实验室参数的必要性。
