A Single-Center Experience of 500 Liver Transplants Using the Modified Piggyback Technique by Belghiti
A Single-Center Experience of 500 Liver Transplants Using the Modified Piggyback Technique by Belghiti
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DOI：
10.1002/lt.21705
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发表时间：
2009-05-01
影响因子：
4.6
通讯作者：
Schmidt, Jan
中科院分区：
文献类型：
--
作者：
Mehrabi, Arianeb;Mood, Zhoobin A.;Schmidt, Jan
在过去的40年里，肝移植（LTx）的手术技术一直在不断发展和改进。其中，Belghiti的改良背驮式（MPB）技术具有独特的优势。本研究的目的是介绍我们在500例病例中使用MPB技术的单中心经验。对受术者围手术期资料进行前瞻性收集和评估。分析两组患者术后及特殊并发症、重症监护和中级监护病房住院情况、死亡率及死因。大多数受助人被归为C类（49.1%）。在首次行LTx的患者中，酒精性肝硬化（23.9%）、病毒性肝硬化（22.2%）和肝细胞癌（15.1%）是常见的适应症。总中位热缺血时间为45分钟，吻合时间为108分钟，手术时间为320分钟。术中失血量中位数为1500ml。无需静脉-静脉旁路维持血流动力学稳定。只有少数病例需要暂时的下腔静脉夹紧。最突出的手术并发症是出血、血肿和伤口裂开。6.2%的患者发生肾功能衰竭。重症监护病房和中级监护病房的总中位住院时间为14天。30天和90天内死亡率分别为6.3%和13.3%。未发生与技术相关的死亡。Belghiti的MPB技术是一种可行且简单的LTx技术。在无肝期保留腔静脉血流，这可以减少静脉旁路或门静脉分流的需要。该技术只需1个腔静脉吻合，无肝期短，易于操作。为了尽量减少流出静脉阻塞的风险，应注意在锁门的方式下对供体下腔静脉进行颅脑宽腔隙造瘘。该技术几乎适用于所有首次肝移植和再移植的患者。中华肝病杂志，2009。(c) 2009年。
Over the past 4 decades, the surgical techniques of liver transplantation (LTx) have permanently evolved and been modified. Among these, the modified piggyback (MPB) technique by Belghiti offers specific advantages. The objective of this study was to present our single-center experience with the MPB technique in 500 cases. Recipients' perioperative data were prospectively collected and evaluated. Postoperative and specific complications, stay in the intensive and intermediate care unit, and the mortality rate with cause of death were analyzed. Most recipients were classified as Child C (49.1%). For the patients who underwent LTx for the first time, alcoholic (23.9%) and viral (22.2%) cirrhosis and hepatocellular carcinoma (15.1%) were the prevalent indications. The overall median warm ischemia time, anastomosis duration, and operative time were 45, 108, and 320 minutes, respectively. The median intraoperative blood loss was 1500 mL. A venovenous bypass was never needed to maintain hemodynamic stability. Only in a few cases was temporary inferior vena cava clamping necessary. Most prominent surgical complications were hemorrhage, hematoma, and wound dehiscence. Renal failure occurred in 6.2% of patients. The overall median stay in the intensive and intermediate care unit was 14 days. The mortality rates within 30 and 90 days were 6.3% and 13.3%, respectively. No technique-related death occurred. The MPB technique by Belghiti is a feasible and simple LTx technique. The caval flow is preserved during the anhepatic phase, and this minimizes the need for venovenous bypass or portocaval shunt. This technique requires only 1 caval anastomosis, which is easy to perform with a short anhepatic phase. To minimize the risk of outflow obstruction, attention should be paid by doing a wide cavocavostomy cranially to the donor inferior vena cava in a door-lock manner. This technique can be applied in almost all patients undergoing LTx for the first time and liver retransplantation as well. Liver Transpl 15:466-474, 2009. (C) 2009 AASLD.