腔静脉成型术在背驮式肝移植术中的应用

目的推荐和总结在实施背驮式肝移植术中采用腔静脉成型术，以期减少术后肝脏流出道梗阻并发症的发生。方法总结2002年1月至2003年4月所实施的23例背驮式肝移植病人，术中实施受体肝静脉成型后，在腔静脉前壁做等腰三角形成型，与供体肝后腔静脉后壁的等腰三角形成型后对口吻合，以减少肝脏流出道梗阻的经验。结果22例病人术中过程顺利，术后恢复良好，无一例发生肝脏流出道梗阻。1例由于术中切肝时误将受体肝后腔静脉横断而改行原位肝移植，术后恢复良好，未发生流出道梗阻。结论在背驮式肝移植术中采用腔静脉成型技术，可以明显降低肝脏流出道梗阻并发症的发生。同时具有简化切肝过程，降低吻合难度，强化移植肝的稳定性，无肝期短的优点。当供受体之间大小存在明显差异时，或实施儿童的减体积性肝移植时该技术具有明显优势。强调用此法切肝时切忌误伤受体肝后腔静脉。

Application of cavaplasty in piggyback liver transplantation

Objective To use cavaplasty in piggyback liver transplantation to reduce hepatic venous outflow obstruction. Methods The clinical data of 23 patients receiving piggyback liver transplantation using cavaplasty in our hospital from January 2002 to April 2003 were retrospectively analyzed. The hepatic outflow could be reduced by the wide-open triangular caval anastomosis. Results There was no hepatic outflow obstruction in 22 cases. The conversion to standard technique for the transection of retrohepatic cava was conducted in only one case. Conclusions The cavaplasty is easy to perform, allowing short implantation time and size-reduced liver grafting to avoid outflow obstruction. The graft is more stable. This technique provides advantages for size mismatching or reduced size liver transplantation in children. The emphasis in cavaplasty is that retrohepatic cava should be preserved from removing the sick liver.