91例肝移植手术方式分析

目的:探讨经典原位肝移植术、改良背驮式肝移植术和原位肝移植腔静脉成形术在临床应用中的利弊。方法:对2001年10月至2003年8月实施的91例肝移植术式进行总结,其中经典原位肝移植术24例(A组),改良背驮式肝移植术43例和改良背驮加术中门鄄腔静脉端侧吻合转流8例(B组),原位肝移植腔静脉成形术16例(C组);91例肝移植手术均未应用体外静脉转流技术。结果:原位肝移植腔静脉成形术的手术时间、无肝期最短(P<0.05),且术中输血量较改良背驮式肝移植术和经典原位肝移植术少(P<0.05)。3组术后ICU留置天数无显著差异(P=0.542)。结论:经典原位肝移植术、改良背驮式肝移植术和原位肝移植腔静脉成形术是肝移植的基本术式;从趋势上看,改良背驮式肝移植术将成为主流术式;对某一个具体病例选择何种术式需根据病情及术中情况决定。

Analysis of Different Operative Procedures in 91 Cases of Liver Transplantation

Objective: To discuss the advantageous and disadvantageous points of traditional orthotopic liver transplantation,modified piggyback liver transplantation and cavaplasty liver transplantation in clinical application. Methods: A comparison was made between operative procedures applied in 91 cases of liver transplantations from October, 2002 to August, 2003. The traditional orthotopic transplantation procedure was used in 24 cases(group A), the modifyied piggyback procedure in 43 cases, the modifyied piggyback procedure with temporary end-to-side portocaval shunt in 8 cases(group B) and the cavaplasty procedure in 16 cases(group C); no femoro-axillary veno-venous bypass was used during operation. Results: Comparing with the traditional orthotopic liver transplantation and piggyback liver transplantation procedure, cavaplasty liver transplantation offered the shortest operative time and anhepatic period(P<0.05); cavaplasty liver transplantation was also accompanied by the least amount of blood loss and blood transfusion(P<0.05), while no significant difference was found in the duration of staying in ICU between the 3 groups. Conclusions: The traditional orthotopic transplantation procedure, the modifyied piggyback and the cavaplasty procedure are commonly used, but the trend shows that modifyied piggyback procedure remains the method of choice, while the other procedure will be choosen under individual circumstances.