摘要
目的 探讨合理的背驮式肝移植（PBLT）静脉回流道重建方式。方法 将 74例 PBLT按不同的静脉回流道重建方式分为5组:肝上下腔静脉-肝静脉端端吻合（A组）、肝上下腔静脉-肝后下腔静脉端侧吻合（B组）、肝后下腔静脉-肝后下腔静脉侧侧吻合（C组）、肝卜下腔静脉-右心房端侧吻合（D组）、肝后下腔静脉-肝后下腔静脉全口吻合（E组）。比较各组受者的中心静脉压（CVP）、肝后下腔静脉压（RHIVC）及供者肝上下腔静脉靠近吻合口部压力（GIVC）,并观察术中布加氏综合征发生情况。结果C组无论是CVP、RHIVC、GIVC,还是压力差均较A组与B组为小,D组与E组血流动力学测定与C组相似。说明该种术式的供肝静脉回流通畅度令人满意,其术中布加氏综合征发生率也较低。结论 供肝静脉回流道重建方式改进后,供肝静脉回流更通畅,布加氏综合征等并发症发生机率减小。故推荐使用供肝肝后下腔静脉与受者肝后下腔静脉侧侧吻合术式。
To explore a reasonable way of venous outflow tract reconstruction in piggy-back liver transplantation (PBLT). Methods 74 cases undergoing PBLT were divided into 5 groups in accordant with the procedures of hepatic venous reconstruction: IVC-HV end to end anastomosis (A) , IVC to IVC end-side anastomosis (B) , IVC to IVC side-side anastomosis (C), hepatic inferior vena cava-right atrium end to side anastomosis (D), retrohepatic IVC-retrohepatic IVC total anastomosis (E). CVP, pressure of recipient's retrohepatic inferior vena cava (RHIVC) and pressure of graft inferior vena cava (GIVC) were compared among the groups, and the occurrence of Buddi-Chairi syndrome observed. Results CVP, pressure of RHIVC and GIVC in the group C were all lower than in the group A and B. The haemodynamics in the groups D and E was similar to that in the group C and the occurrence of Buddi-Chairi syndrome was lower too. Conclusions The new way of venous outflow tract reconstruction in piggy-back liver transplantation makes blood reflow more fluent and drops the occurrence rate of Buddi-Chairi syndrome during operation. It is recommended to use recipient's retrohepatic IVC-graft retro-hepatic IVC side-side anastomosis.
出处
《中华器官移植杂志》
CAS
CSCD
北大核心
2002年第4期202-203,共2页
Chinese Journal of Organ Transplantation
