Total Hepatectomy and Liver Transplantation as Two‐stage Procedure
Total Hepatectomy and Liver Transplantation as Two‐stage Procedure
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全肝切除术和肝移植作为两阶段手术
DOI：
10.1097/00000658-199307000-00002
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发表时间：
1993
影响因子：
9
通讯作者：
R. Pichlmayr
中科院分区：
文献类型：
--
作者：
B. Ringe;N. Lübbe;E. Kuse;U. Frei;R. Pichlmayr
本文介绍了在特殊紧急情况下，临床肝移植中延长无肝期的桥接程序的经验。由于暴发性肝炎或急性移植物衰竭引起的肝坏死，以及严重的肝外伤是众所周知的紧急肝移植的适应症。前提是分配合适的捐赠器官。如果不能及时获得同种异体移植物，患者会出现“中毒性肝综合征”。或放血性出血已被证明受益于先进的全肝切除术。方法作为标准一期手术的改进，受体肝切除和随后的肝移植在两个单独的手术中进行。为了弥补无肝期延长，并允许减压和静脉血回流，暂时建立端侧门腔静脉分流。结果32例患者中13例因病情恶化，行肝切除术后未行肝移植，均在34 h内死亡。在32例患者中，19例在肝切除术后6-41小时实现移植; 19例患者中有9例死亡，大多数死于败血症。19例肝移植受者中有10例存活，包括3例不相关的晚期死亡;目前，7例患者存活，随访3至46个月。结论二期全肝切除联合临时性门腔静脉分流术和随后的肝移植可以挽救那些最有可能死于晚期肝或移植物坏死或失血后遗症的患者的生命，这些后遗症不能通过常规治疗或立即肝移植来控制。
ObjectiveThis article describes the experience with a bridging procedure for a prolonged anhepatic period during clinical liver transplantation in case of special emergency situations. Summary Background DataHepatic necrosis due to fulminant hepatitis or acute graft failure, as well as severe liver trauma are well-known and accepted indications for urgent liver transplantation. Prerequisite is the allocation of a suitable donor organ. If no allograft is available in time, patients with “toxic liver syndrome.” or exsanguinating hemorrhage have been shown to benefit from advanced total hepatectomy. MethodsAs a modification of the standard one-stage procedure, recipient hepatectomy and subsequent liver transplantation are performed in two separate operations. To bridge the prolonged anhepatic period and to allow decompression and return of venous blood, an end-to-side portocaval shunt is constructed temporarily. ResultsThirteen of thirty-two patients underwent hepatectomy but not transplantation subsequently, and died within 34 hours after progressive deterioration. In 19 of 32 patients, transplantation was realized 6–41 hours after hepatectomy; 9 of 19 patients died, mostly from sepsis. Ten of nineteen liver recipients survived the procedure including three unrelated late deaths; presently, seven patients are alive with a follow-up of 3 to 46 months. ConclusionsTwo-stage total hepatectomy with temporary portocaval shunt, and subsequent liver transplantation can be a life-saving approach in patients most likely to die of the sequelae of advanced liver or graft necrosis or exsanguination that cannot be controlled by conventional treatment or immediate liver transplantation.