Steib A, Saada A, Clever B, Lehmann C, Freys G, Levy S, Boudjema K
Department of Anesthesiology, Hôpitaux Universitaires de Strasbourg, France.
Liver Transpl Surg. 1997 Sep;3(5):518-25. doi: 10.1002/lt.500030507.
Conventional liver transplantation requires cross-clamping of the hepatic pedicle and inferior vena cava, leading to severe hemodynamic and metabolic disturbances, usually attenuated by the use of venovenous bypass. A more recent surgical technique, piggyback with temporary portocaval shunting, preserves both caval and portal blood flows. The aim of this study was to compare the two methods prospectively. Forty-four patients with chronic liver disease were studied. Local anatomic conditions guided the surgeon to choose the easiest way to remove the native liver. Anesthetic management was standardized. Hemodynamic and metabolic changes were assessed by use of routine tests at specific periods. Graft function was evaluated by measurement of aminotransferases and monoethylglycinexylidide (MEGX) test 12, 24, 48, and 72 hours postoperatively. Conventional liver transplantation with venovenous bypass was performed in 26 patients, and the piggyback with temporary portocaval shunting was performed in 15 patients. ANOVA showed that cardiac output and systemic oxygen delivery were better maintained before revascularization in the piggyback group. Metabolic changes were comparable, and hyperfibrinolytic activity was detected in both groups. Graft function was comparable and satisfactory within the 3 first postoperative days. Piggyback with temporary portocaval shunting provided better intraoperative hemodynamics and tissue oxygenation than liver transplantation with venovenous bypass.
传统肝移植需要钳夹肝蒂和下腔静脉，这会导致严重的血流动力学和代谢紊乱，通常通过使用静脉-静脉转流来减轻。一种更新的手术技术，即背驮式肝移植联合临时门腔分流术，可保留腔静脉和门静脉的血流。本研究的目的是对这两种方法进行前瞻性比较。对44例慢性肝病患者进行了研究。局部解剖条件指导外科医生选择切除病肝的最简单方法。麻醉管理标准化。在特定时间段通过常规检查评估血流动力学和代谢变化。术后12、24、48和72小时通过测量转氨酶和单乙甘氨酰二甲苯（MEGX）试验评估移植物功能。26例患者接受了带静脉-静脉转流的传统肝移植，15例患者接受了背驮式肝移植联合临时门腔分流术。方差分析显示，背驮式肝移植组在血管再通前的心输出量和全身氧输送得到更好的维持。代谢变化相当，两组均检测到高纤溶活性。术后前3天移植物功能相当且良好。与带静脉-静脉转流的肝移植相比，背驮式肝移植联合临时门腔分流术在术中提供了更好的血流动力学和组织氧合。
