Chkhaidze Z, Khodeli N, Pilishvili O, Partsakhashvili D, Jangavadze M, Kordzaia D
Department of Clinical Anatomy and Operative Surgery, A. Natishvili Institute of Morphology, I. Javakhishvili State University, Tbilisi, Georgia.
Transplant Proc. 2013 Jun;45(5):1734-8. doi: 10.1016/j.transproceed.2012.10.049.
Blood is shunted from the inferior vena cava and portal vein to the superior vena caval system to prevent congestion in the lower parts of the body during the anhepatic phase (AP) of liver transplantation. It leads to overload in the superior vena caval system retarding cranial outflow due to a nonphysiological blood redistribution. To overcome this problem, we developed a new bypass in dogs: blood is shunted from the inferior (caudal) vena cava and portal vein to the suprahepatic inferior (caudal) vena cava. This model was compared with traditional one with or without a pump. Blood pressure and flow parameters were estimated during 3 hours of AP in four groups of four dogs each. The current study showed that a nontraditional scheme of venous bypass reduced circulatory complications during AP, especially in the cranial vena caval system, although a low rate of congestion remains in the caudal vena cava and portal vein systems. Whereas the same scheme using a pump effectively prevented congestion in all of the systems: cranial, caudal, and portal. We concluded that application of a nontraditional bypass scheme, providing venous blood return into suprahepatic part of caudal vena cava, can be considered to be a method of choice for experimental liver transplantation.
在肝移植的无肝期（AP），血液从下腔静脉和门静脉分流至上腔静脉系统，以防止身体下部出现充血。由于非生理性的血液重新分布，这会导致上腔静脉系统负荷过重，阻碍颅部血流流出。为克服这一问题，我们在犬类中开发了一种新的旁路：血液从下（尾）腔静脉和门静脉分流至肝上的下（尾）腔静脉。将该模型与有或无泵的传统模型进行比较。在四组实验中，每组四只犬，在无肝期3小时内评估血压和血流参数。当前研究表明，非传统的静脉旁路方案可减少无肝期的循环并发症，尤其是在上腔静脉系统中，尽管下腔静脉和门静脉系统中仍有较低的充血发生率。而使用泵的相同方案可有效防止所有系统（颅部、尾部和门静脉）出现充血。我们得出结论，应用非传统的旁路方案，使静脉血回流至肝上下腔静脉部分，可被视为实验性肝移植的一种首选方法。
