各种外科技术在肝移植中的应用：一项回顾性研究。

Application of various surgical techniques in liver transplantation: a retrospective study.

作者信息

Chen Zhitao, Ju Weiqiang, Chen Chuanbao, Wang Tielong, Yu Jia, Hong Xitao, Dong Yuqi, Chen Maogen, He Xiaoshun

机构信息

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.

出版信息

Ann Transl Med. 2021 Sep;9(17):1367. doi: 10.21037/atm-21-1945.

DOI:10.21037/atm-21-1945

PMID:34733919

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8506559/

Abstract

BACKGROUND

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.

METHODS

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)].

RESULTS

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).

CONCLUSIONS

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.

摘要

背景

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。

方法

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。

结果

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）。