Johnson S R, Marterre W F, Alonso M H, Hanto D W
University of Cincinnati College of Medicine, Department of Surgery, OH 45267-0558, USA.
Liver Transpl Surg. 1996 Sep;2(5):354-61. doi: 10.1002/lt.500020505.
Venovenous bypass minimizes the hemodynamic alterations during the anhepatic phase of liver transplantation. A new technique for the percutaneous placement of the bypass cannulae is described and compared to the cut-down ("open") technique. The records of 81 patients who underwent 94 liver transplants between August 1991 and April 1994 were reviewed for indications for transplant, United Network for Organ Sharing status, mean age, body surface area, bypass technique and time, flow rates, cardiac output, mean arterial pressure and central venous pressure during bypass, the development of deep venous thrombophlebitis, and lymphoceles. Femoral flow rates were higher in the open group (2054 +/- 74 mL/min), compared with the percutaneous group (1726 +/- 74 mL/min) (p = 0.003). Total flow rates in the open (2238 +/- 58 mL/min) and percutaneous (2197 +/- 67 mL/min) groups were not different. Maximum cardiac outputs (L/ min) were higher in the open (10.1 +/- 0.6) versus percutaneous group (7.0 +/- 0.5) (p < 0.0002). Similarly, minimum cardiac outputs (L/min) were higher in the open (8.9 +/- 0.7) versus percutaneous group (5.8 +/- 0.5) (p = 0.003). Other hemodynamic parameters (mean arterial pressure, central venous pressure) were not different between groups. Venous thrombosis occurred in 1/50 (2.0%) and 4/34 (11.8%) patients in the open and percutaneous groups, respectively (p = 0.153). Nineteen lymphoceles occurred in 102 (18.6%) at-risk sites in the open group, whereas no lymphoceles occurred in 66 at-risk sites in the percutaneous group (p < 0.001). Groin lymphoceles occurred in 7/50 (14%) and 0/34 at-risk sites in the open and percutaneous groups, respectively (p = 0.039). Axillary lymphoceles occurred in 12/52 (23.1%) and 0/32 at-risk sites in the open and percutaneous groups, respectively (p = 0.0031). Operative repair of a lymphocele was required in 11/16 (69%) patients. The percutaneous placement of catheters for venovenous bypass has the advantage of comparable flow rates with satisfactory hemodynamics without the lymphatic complications of the cut-down technique.
静脉-静脉转流可使肝移植无肝期的血流动力学改变降至最低。本文描述了一种经皮放置转流套管的新技术，并与切开（“开放”）技术进行了比较。回顾了1991年8月至1994年4月期间接受94例肝移植的81例患者的记录，内容包括移植指征、器官共享联合网络状态、平均年龄、体表面积、转流技术及时间、流速、心输出量、转流期间的平均动脉压和中心静脉压、深静脉血栓性静脉炎的发生情况以及淋巴囊肿。开放组的股动脉流速（2054±74 mL/分钟）高于经皮组（1726±74 mL/分钟）（p = 0.003）。开放组（2238±58 mL/分钟）和经皮组（2197±67 mL/分钟）的总流速无差异。开放组的最大心输出量（L/分钟）（10.1±0.6）高于经皮组（7.0±0.5）（p < 0.0002）。同样，开放组的最小心输出量（L/分钟）（8.9±0.7）高于经皮组（5.8±0.5）（p = 0.003）。两组间其他血流动力学参数（平均动脉压、中心静脉压）无差异。开放组和经皮组分别有1/50（2.0%）和4/34（11.8%）的患者发生静脉血栓形成（p = 0.153）。开放组102个（18.6%）风险部位出现19个淋巴囊肿，而经皮组66个风险部位未出现淋巴囊肿（p < 0.001）。腹股沟淋巴囊肿在开放组和经皮组的风险部位分别有7/50（14%）和0/34出现（p = 0.039）。腋窝淋巴囊肿在开放组和经皮组的风险部位分别有12/52（23.1%）和0/32出现（p = 0.0031）。11/16（69%）的患者需要对淋巴囊肿进行手术修复。经皮放置静脉-静脉转流导管具有流速相当、血流动力学良好且无切开技术的淋巴并发症的优点。
