Kim J D, Choi D L
Division of Hepatobiliary Pancreas Surgery and Abdominal Organ Transplantation, Department of Surgery, Catholic University of Daegu College of Medicine, Daegu, Korea.
Division of Hepatobiliary Pancreas Surgery and Abdominal Organ Transplantation, Department of Surgery, Catholic University of Daegu College of Medicine, Daegu, Korea.
Transplant Proc. 2015 Apr;47(3):694-9. doi: 10.1016/j.transproceed.2014.12.036.
Although a temporary portocaval shunt (TPCS) improves hemodynamic stability during liver transplantation, the role of TPCS is controversial. We assessed the effects of TPCS in patients undergoing living-donor liver transplantation (LDLT) with a difficult total hepatectomy.
We analyzed outcomes by means of retrospective review of 116 LDLTs performed in our institution from May 2011 to October 2013; among these, 33 recipients received TPCS (group I) and 83 did not (group II). We performed TPCS in a high-risk group, such as those with severe perihepatic adhesions, severe retrohepatic adhesions to the vena cava, or massive bleeding during total hepatectomy. Patient demographics and intraoperative and postoperative variables were reviewed.
No significant differences were observed in the perioperative variables except intraoperative blood loss. The transfusion requirement and operative time in group I were similar to those in group II despite the higher blood loss and more complicated cases. Hemodynamic status and the vasopressor requirement during the operation were similar between the 2 groups. We also compared 2 subgroups to evaluate the effects of TPCS more precisely in the high-risk patients: subgroup A (Model for End-Stage Liver Disease score [MELD], >20) and subgroup B (MELD, ≤20). The intraoperative requirements for platelet concentrate and epinephrine during the early reperfusion phase in subgroup A were significantly lower than those in subgroup A without TPCS.
TPCS was a safe and useful procedure to improve hemodynamic status and postoperative LDLT outcomes in high-risk and select patients.
尽管临时门腔分流术（TPCS）可改善肝移植期间的血流动力学稳定性，但其作用仍存在争议。我们评估了TPCS在活体肝移植（LDLT）中实施困难的全肝切除患者中的效果。
我们通过回顾性分析2011年5月至2013年10月在我院进行的116例LDLT的结果；其中，33例受者接受了TPCS（I组），83例未接受（II组）。我们在高危组中实施TPCS，例如那些有严重肝周粘连、严重肝后腔静脉粘连或全肝切除术中大量出血的患者。回顾了患者的人口统计学资料以及术中、术后变量。
除术中失血量外，围手术期变量未观察到显著差异。尽管I组失血量更多且病例更复杂，但其输血需求和手术时间与II组相似。两组手术期间的血流动力学状态和血管升压药需求相似。我们还比较了两个亚组，以更精确地评估TPCS在高危患者中的效果：A亚组（终末期肝病模型评分[MELD]，>20）和B亚组（MELD，≤20）。A亚组在早期再灌注阶段对浓缩血小板和肾上腺素的术中需求显著低于未进行TPCS的A亚组。
TPCS是一种安全有效的手术方法，可改善高危和特定患者的血流动力学状态及LDLT术后结果。
