González F X, García-Valdecasas J C, Grande L, Pacheco J L, Cugat E, Fuster J, Lacy A M, Taurá P, López-Boado M A, Rimola A, Visa J
Department of Surgery, Hospital Clínic i Provincial of Barcelona, University of Barcelona, Spain.
Liver Transpl Surg. 1998 Mar;4(2):133-40. doi: 10.1002/lt.500040206.
The aim of this study was to evaluate the influence of preserving the recipient's inferior vena cava during orthotopic liver transplantation (OLT) on hemodynamic alterations, blood component requirements, postoperative liver and renal function, as well as vascular-related complications. A total of 122 OLTs was studied. In 35 OLTs, venovenous bypass (BP) was used; in 35 OLTs, bypass was not used (NBP); and in 52 OLTs, the recipient's inferior vena cava was preserved (PC). Preservation of the inferior vena cava means that venous return is not compromised at any time during transplantation. The time of hepatectomy was not different among the three groups (208 +/- 11, 188 +/- 13, and 194 +/- 6 minutes for BP, NBP, and PC, respectively); however, the total operating time was significantly lower in PC patients (492 +/- 24, 459 +/- 18, and 419 +/- 10 minutes for BP, NBP, and PC, respectively; P = .004, ANOVA). Blood component requirements were significantly lower in patients with PC. For red blood cells, these were 15.2 +/- 2.6, 16 +/- 3.4, and 7.1 +/- 1.5 units for BP, NBP, and PC, respectively (P = .009, ANOVA), and for fresh-frozen plasma, these were 5.4 +/- .7, 5.8 +/- .9, and 3 +/- .4 L for BP, NBP, and PC, respectively (P = .005, ANOVA). Postoperative liver and renal function did not differ among the three groups. The incidence of surgical complications (bleeding and vascular) was similar. Preservation of the inferior vena cava of the recipient significantly reduces the magnitude of OLT.
本研究旨在评估原位肝移植（OLT）期间保留受体下腔静脉对血流动力学改变、血液成分需求、术后肝肾功能以及血管相关并发症的影响。共研究了122例OLT。35例OLT采用静脉-静脉转流（BP）；35例OLT未采用转流（NBP）；52例OLT保留了受体下腔静脉（PC）。保留下腔静脉意味着在移植过程中的任何时候静脉回流都不会受到影响。三组之间肝切除时间无差异（BP组、NBP组和PC组分别为208±11、188±13和194±6分钟）；然而，PC组患者的总手术时间显著缩短（BP组、NBP组和PC组分别为492±24、459±18和419±10分钟；P = 0.004，方差分析）。PC组患者的血液成分需求显著降低。对于红细胞，BP组、NBP组和PC组分别为15.2±2.6、16±3.4和7.1±1.5单位（P = 0.009，方差分析）；对于新鲜冰冻血浆，BP组、NBP组和PC组分别为5.4±0.7、5.8±0.9和3±0.4 L（P = 0.005，方差分析）。三组术后肝肾功能无差异。手术并发症（出血和血管相关）的发生率相似。保留受体下腔静脉可显著降低OLT的程度。
