Fleitas M G, Casanova D, Martino E, Maestre J M, Herrera L, Hernanz F, Rabanal J M, Pulgar S, Solares G
Department of General Surgery, Hospital Universitario Marques of Valdecilla, Cantabria University, Santander, Spain.
Arch Surg. 1994 Aug;129(8):842-5. doi: 10.1001/archsurg.1994.01420320068013.
To determine if orthotopic liver transplantation with inferior vena cava preservation, performed without using caval cross clamping or venovenous bypass, can minimize hemodynamic instability and low renal perfusion pressure.
A prospective case series of 44 consecutive adult orthotopic liver transplantations, with a maximum follow-up of 30 months.
An institutional university referral center.
Between November 1990 and May 1993, 39 consecutive adult liver transplant recipients underwent transplantation with the following primary diagnoses: alcoholic cirrhosis (n = 23), viral cirrhosis (n = 9), primary biliary cirrhosis (n = 2), Wilson's disease (n = 2), primary sclerosing cholangitis (n = 1), fulminant hepatic failure (n = 1), and secondary hepatic malignant neoplasm (n = 1); five had repeated orthotopic liver transplantation.
Orthotopic liver transplantations were performed using the piggyback technique, but with placement of the vascular clamp on the inferior vena cava laterally instead of across it so that it remained patent throughout the anhepatic stage. Favorable anatomic conditions in the recipients were not considered; venovenous bypass was not used.
Intraoperative hemodynamic profile, blood loss and replacement, surgical time and complications, and patient survival.
No significant hemodynamic changes with lateral clamping and no increases in surgical complications, rate of retransplantation, blood product requirements, or survival rate compared with the standard procedure.
The piggyback operation could be routinely used in orthotopic liver transplantation.
确定在不使用腔静脉交叉钳夹或静脉-静脉转流的情况下进行保留肝下下腔静脉的原位肝移植，是否能将血流动力学不稳定和低肾灌注压降至最低。
一项前瞻性病例系列研究，连续纳入44例成人原位肝移植患者，最长随访30个月。
一所大学附属医院转诊中心。
1990年11月至1993年5月，39例连续的成人肝移植受者接受移植，主要诊断如下：酒精性肝硬化（n = 23）、病毒性肝硬化（n = 9）、原发性胆汁性肝硬化（n = 2）、威尔逊病（n = 2）、原发性硬化性胆管炎（n = 1）、暴发性肝衰竭（n = 1）和继发性肝恶性肿瘤（n = 1）；5例接受过再次原位肝移植。
采用背驮式技术进行原位肝移植，但将血管钳放置在肝下下腔静脉外侧而非横跨该静脉，以便在无肝期全程保持其通畅。未考虑受者的有利解剖条件；未使用静脉-静脉转流。
术中血流动力学参数、失血量及补充量、手术时间和并发症以及患者生存率。
与标准手术相比，侧方钳夹时无显著血流动力学变化，手术并发症、再次移植率、血制品需求量或生存率均无增加。
背驮式手术可常规用于原位肝移植。
