Chen Zhitao, Ju Weiqiang, Chen Chuanbao, Wang Tielong, Yu Jia, Hong Xitao, Dong Yuqi, Chen Maogen, He Xiaoshun
Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.
Ann Transl Med. 2021 Sep;9(17):1367. doi: 10.21037/atm-21-1945.
Surgical techniques of liver transplantation have continually evolved and have been modified. We retrospectively analyzed a single-center case series and compared the advantages and disadvantages of each method.
Six-hundred and seventy-four recipients' perioperative data were assessed and analyzed stratified by different surgical technics [modified classic (MC), modified piggyback (MPB) and classic piggyback (CPB)].
MELD score and Child-Pugh scores was significantly higher in CPB groups (P=0.008 and 0.003, respectively). Anhepatic time in MPB group was longer than those in CPB group (P<0.05). The operation duration in MPB group was significantly longer than those in MC group and CPB group (P=0.003). Three patients had outflow obstruction (P=0.035). The overall survival in MPB group were better than those in MC group and CPB group in general comparison (P<0.001). In patients with preoperative creatine >120 µmol/L, the overall survival in MC group was worst (P<0.001). In patients with a high MELD score (>24), the overall survival in MPB group tended to be the best (P<0.001).
The advantages and disadvantages are different for these three surgical techniques. A reasonable operation technique should be adopted considering the patient's unique condition to ensure the stability of hemodynamics.
肝移植手术技术不断发展并得到改进。我们回顾性分析了一个单中心病例系列，并比较了每种方法的优缺点。
评估并分析了674例接受者的围手术期数据，并根据不同的手术技术[改良经典术式（MC）、改良背驮式（MPB）和经典背驮式（CPB）]进行分层。
CPB组的终末期肝病模型（MELD）评分和Child-Pugh评分显著更高（分别为P = 0.008和0.003）。MPB组的无肝期长于CPB组（P < 0.05）。MPB组的手术时间显著长于MC组和CPB组（P = 0.003）。3例患者出现流出道梗阻（P = 0.035）。总体比较中，MPB组的总体生存率优于MC组和CPB组（P < 0.001）。术前肌酐>120 μmol/L的患者中，MC组的总体生存率最差（P < 0.001）。在MELD评分高（>24）的患者中，MPB组的总体生存率往往最佳（P < 0.001）。
这三种手术技术的优缺点各不相同。应根据患者的独特情况采用合理的手术技术，以确保血流动力学的稳定。
