Background Liver transplantation in Budd-Chiari syndrome remains controversial; however, some improved techniques lead to better results. We report medium-term follow-up results of liver transplantation with atrioatri...Background Liver transplantation in Budd-Chiari syndrome remains controversial; however, some improved techniques lead to better results. We report medium-term follow-up results of liver transplantation with atrioatrial anastomosis for Budd-Chiari syndrome and explore the indications of liver transplantation with atrioatrial anastomosis for patients with end stage liver disease.Methods Nine patients （six Budd-Chiari syndromes, one end stage hepatolithiasis, one hepatocellular carcinoma and one incurable alveolar echinococcosis） underwent liver transplantation with atrioatrial anastomosis in West China Hospital of Sichuan University from 1999 to 2006. Eight liver transplants used cadaveric orthotopic livers and one a living donor liver. The operative technique was transdiaphragmatic exposure for direct atrioatrial anastomosis and replacement of inferior vena cava by cryopreserved vena cava graft with the help of venovenous bypass.Results All liver transplantations were successful. Two patients contracted pulmonary infection and acute rejection took place in another case. With proper treatment, all patients recovered well and had good quality of life. To date, they have been followed up for more than 24 months. The only death followed recurrence of hepatic carcinoma three years after liver transplantation.Conclusions Transdiaphragmatic exposure for direct atrioatrial anastomosis and the cryopreserved vena cava graftreplacement of inferior vena cava are possible for patients with end stage liver disease thus extending the indications of liver transplantation.展开更多
BACKGROUND: To evaluate feasibility and safety of venovenous bypass prior to mobilization of the liver during orthotopic liver transplantation (OLT). METHODS: Fifty-four patients were classified into two groups. Group...BACKGROUND: To evaluate feasibility and safety of venovenous bypass prior to mobilization of the liver during orthotopic liver transplantation (OLT). METHODS: Fifty-four patients were classified into two groups. Group A consisted of 23 patients receiving OLT with classical venovenous bypass. Group B consisted of 31 patients who received a modified-procedure: venovenous bypass ahead of the mobilization of the liver during ULT. The blood loss, duration of venovenous bypass, cold ischemia time, anhepatic phase, and transfusion during operation in the two groups were compared. Complications after the operation were also compared between the two groups. RESULTS: The duration of venovenous bypass and cold ischemia time in group A were longer than those in group B [(99.78±21.36 min) vs (96.32±22.25 min) and (484.78±134.01 min) vs (443.15± 85.27 min)]. The anhepatic phase lasted for about 100 min averagely in the two groups. The volumes of blood loss and transfusion during the operation were larger in group A than in group B [(5096±4243 ml) vs (1726±1125 ml) and (3676±2938.74 ml) vs (1217.69±829.72 ml)]. Postoperative complications occurred in 26 patients of group A and in 19 patients of group B. CONCLUSION: This modified-procedure or venovenous bypass ahead of mobilization of the liver in OLT can reduce the blood loss during OLT and the incidence of postoperative complications without prolongation of the anhepatic phase and duration of venovenous bypass.展开更多
A renal mass with level Level IV IVC thrombus is usually managed with radical nephrectomy and IVC thrombectomy. This procedure requires the assistance of a cardiac surgeon and is usually done under complete cardiopulm...A renal mass with level Level IV IVC thrombus is usually managed with radical nephrectomy and IVC thrombectomy. This procedure requires the assistance of a cardiac surgeon and is usually done under complete cardiopulmonary bypass. However, the use of cardiopulmonary bypass is associated with reduced cardiac venous return and can consequently decrease cardiac output, adversely affecting haemo-dynamic stability and systemic arterial perfusion. This can lead to relative ischemia of the abdominal viscera, lower limbs and kidneys. We report a case where radical nephrectomy with IVC thrombectomy was done under venovenous bypass, thus avoiding the complications associated with the cardiopulmonary bypass.展开更多
There are several caval reconstruction techniques currently in use for orthotopic liver transplantation. These include caval replacement or the conventional technique, performed with or without venovenous bypass, pigg...There are several caval reconstruction techniques currently in use for orthotopic liver transplantation. These include caval replacement or the conventional technique, performed with or without venovenous bypass, piggyback technique with anastomosis with two or three hepatic veins with or without cavotomy and modifications of the piggyback technique including end-to-side and side-to-side cavocaval anastomosis. There are few randomized controlled trials comparing the use of these techniques and our knowledge of their comparability is based on a few multi- and many single-center retrospective and prospective reviews. Although there are advantages and disadvantages for each technique, it is advisable that the surgeon perform the technique with which they have the most the experience and at which they are the most skilled as excellent outcomes can be obtained with any of the caval reconstruction options discussed.展开更多
目的:观察非静脉转流下,经典原位肝移植病人围术期电解质浓度和血流动力学变化。方法:9例经典原位肝移植病人在非静脉转流下,行气管插管静吸复合麻醉,术中经颈静脉双腔管持续监测CVP,桡动脉置管监测ABP。于手术各期定时抽取桡动脉血行...目的:观察非静脉转流下,经典原位肝移植病人围术期电解质浓度和血流动力学变化。方法:9例经典原位肝移植病人在非静脉转流下,行气管插管静吸复合麻醉,术中经颈静脉双腔管持续监测CVP,桡动脉置管监测ABP。于手术各期定时抽取桡动脉血行血气分析,测定钠、钾、钙浓度。常规持续监测HR,SpO2,PETCO2及体温。结果:本组9例围手术期血钙持续偏低,无肝期和再灌注前期尤为明显。无肝期前期(5 m in)及再灌注前期(5 m in)血钾轻度上升,无肝期中期(30 m in)及再灌注中期(30 m in)血钠轻度上升,但极少超出正常范围,病人血流动力学稳定后逐渐恢复诱导后水平。进入无肝期后,大部分病人血压一过性明显下降,其余时间段均较平稳。结论:非静脉转流原位肝移植,无肝期及再灌注期应注意纠正低血钙,无肝期前期(5 m in)及再灌注前期(5 m in)应警惕高血钾发生。进入无肝期前应适当扩容,无肝期中应用血管活性药物维持血压,及时根据病人失血量及血球压积补充血容量,尽可能维持围术期循环稳定,防止再灌注前期严重酸中毒的发生。展开更多
文摘Background Liver transplantation in Budd-Chiari syndrome remains controversial; however, some improved techniques lead to better results. We report medium-term follow-up results of liver transplantation with atrioatrial anastomosis for Budd-Chiari syndrome and explore the indications of liver transplantation with atrioatrial anastomosis for patients with end stage liver disease.Methods Nine patients （six Budd-Chiari syndromes, one end stage hepatolithiasis, one hepatocellular carcinoma and one incurable alveolar echinococcosis） underwent liver transplantation with atrioatrial anastomosis in West China Hospital of Sichuan University from 1999 to 2006. Eight liver transplants used cadaveric orthotopic livers and one a living donor liver. The operative technique was transdiaphragmatic exposure for direct atrioatrial anastomosis and replacement of inferior vena cava by cryopreserved vena cava graft with the help of venovenous bypass.Results All liver transplantations were successful. Two patients contracted pulmonary infection and acute rejection took place in another case. With proper treatment, all patients recovered well and had good quality of life. To date, they have been followed up for more than 24 months. The only death followed recurrence of hepatic carcinoma three years after liver transplantation.Conclusions Transdiaphragmatic exposure for direct atrioatrial anastomosis and the cryopreserved vena cava graftreplacement of inferior vena cava are possible for patients with end stage liver disease thus extending the indications of liver transplantation.
文摘BACKGROUND: To evaluate feasibility and safety of venovenous bypass prior to mobilization of the liver during orthotopic liver transplantation (OLT). METHODS: Fifty-four patients were classified into two groups. Group A consisted of 23 patients receiving OLT with classical venovenous bypass. Group B consisted of 31 patients who received a modified-procedure: venovenous bypass ahead of the mobilization of the liver during ULT. The blood loss, duration of venovenous bypass, cold ischemia time, anhepatic phase, and transfusion during operation in the two groups were compared. Complications after the operation were also compared between the two groups. RESULTS: The duration of venovenous bypass and cold ischemia time in group A were longer than those in group B [(99.78±21.36 min) vs (96.32±22.25 min) and (484.78±134.01 min) vs (443.15± 85.27 min)]. The anhepatic phase lasted for about 100 min averagely in the two groups. The volumes of blood loss and transfusion during the operation were larger in group A than in group B [(5096±4243 ml) vs (1726±1125 ml) and (3676±2938.74 ml) vs (1217.69±829.72 ml)]. Postoperative complications occurred in 26 patients of group A and in 19 patients of group B. CONCLUSION: This modified-procedure or venovenous bypass ahead of mobilization of the liver in OLT can reduce the blood loss during OLT and the incidence of postoperative complications without prolongation of the anhepatic phase and duration of venovenous bypass.
文摘A renal mass with level Level IV IVC thrombus is usually managed with radical nephrectomy and IVC thrombectomy. This procedure requires the assistance of a cardiac surgeon and is usually done under complete cardiopulmonary bypass. However, the use of cardiopulmonary bypass is associated with reduced cardiac venous return and can consequently decrease cardiac output, adversely affecting haemo-dynamic stability and systemic arterial perfusion. This can lead to relative ischemia of the abdominal viscera, lower limbs and kidneys. We report a case where radical nephrectomy with IVC thrombectomy was done under venovenous bypass, thus avoiding the complications associated with the cardiopulmonary bypass.
文摘There are several caval reconstruction techniques currently in use for orthotopic liver transplantation. These include caval replacement or the conventional technique, performed with or without venovenous bypass, piggyback technique with anastomosis with two or three hepatic veins with or without cavotomy and modifications of the piggyback technique including end-to-side and side-to-side cavocaval anastomosis. There are few randomized controlled trials comparing the use of these techniques and our knowledge of their comparability is based on a few multi- and many single-center retrospective and prospective reviews. Although there are advantages and disadvantages for each technique, it is advisable that the surgeon perform the technique with which they have the most the experience and at which they are the most skilled as excellent outcomes can be obtained with any of the caval reconstruction options discussed.
文摘目的:观察非静脉转流下,经典原位肝移植病人围术期电解质浓度和血流动力学变化。方法:9例经典原位肝移植病人在非静脉转流下,行气管插管静吸复合麻醉,术中经颈静脉双腔管持续监测CVP,桡动脉置管监测ABP。于手术各期定时抽取桡动脉血行血气分析,测定钠、钾、钙浓度。常规持续监测HR,SpO2,PETCO2及体温。结果:本组9例围手术期血钙持续偏低,无肝期和再灌注前期尤为明显。无肝期前期(5 m in)及再灌注前期(5 m in)血钾轻度上升,无肝期中期(30 m in)及再灌注中期(30 m in)血钠轻度上升,但极少超出正常范围,病人血流动力学稳定后逐渐恢复诱导后水平。进入无肝期后,大部分病人血压一过性明显下降,其余时间段均较平稳。结论:非静脉转流原位肝移植,无肝期及再灌注期应注意纠正低血钙,无肝期前期(5 m in)及再灌注前期(5 m in)应警惕高血钾发生。进入无肝期前应适当扩容,无肝期中应用血管活性药物维持血压,及时根据病人失血量及血球压积补充血容量,尽可能维持围术期循环稳定,防止再灌注前期严重酸中毒的发生。
