De Carlis L, Doglia M, Fassati L R, Rossi G, Tarenzi L, Galmarini D
Int Surg. 1986 Apr-Jun;71(2):76-8.
It is now widely accepted that a veno-venous bypass is required to minimize the problems of the anhepatic phase in orthotopic liver transplantation. A technique that does not require systemic anticoagulation is needed to prevent damage by heparinization in hepatic patients. The use of heparin-bonded cannulas offers low risks of thromboembolic complication. Fourteen orthotopic liver transplantation were performed in pigs, including 7 with a roller pump and 7 with a centrifugal pump, without systemic anticoagulation and with heparin-bonded circuits except for the portal cannula, connectors, centrifugal pump head and the tract of the circuit on which the roller moves. All the circuits were previously utilized in clinical liver transplantation and repeatedly washed in saline solution and sterilized for each experiment. The haemodynamic control of the anhepatic state was excellent without hypotension and venous engorgement. In only one case a thromboembolic complication was noted. Arterial pressure, heart rate, urine flow, creatinine, arterial pH and thromboelastographic data did not change significantly while on bypass. No difference was found in the use of either a roller or a centrifugal pump even when the blood flow fell to less than 1000 ml/min to 500 ml/min.
现在人们普遍认为，在原位肝移植中需要进行静脉-静脉转流，以尽量减少无肝期的问题。需要一种不需要全身抗凝的技术来防止肝病患者因肝素化而受到损害。使用肝素结合插管可降低血栓栓塞并发症的风险。对猪进行了14例原位肝移植，其中7例使用滚压泵，7例使用离心泵，除门静脉插管、连接器、离心泵头以及滚压泵移动的回路部分外，均采用肝素结合回路且不进行全身抗凝。所有回路均曾用于临床肝移植，并在每次实验前用盐溶液反复冲洗并消毒。无肝期的血流动力学控制良好，未出现低血压和静脉充血。仅1例出现血栓栓塞并发症。转流期间，动脉压、心率、尿量、肌酐、动脉pH值和血栓弹力图数据无明显变化。即使血流降至1000毫升/分钟至500毫升/分钟以下，使用滚压泵或离心泵也未发现差异。
