Specific vascular complications of orthotopic liver transplantation with preservation of the retrohepatic vena cava: Review of 1361 cases
Specific vascular complications of orthotopic liver transplantation with preservation of the retrohepatic vena cava: Review of 1361 cases
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DOI：
10.1097/00007890-199909150-00009
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发表时间：
1999-09-15
期刊：
影响因子：
6.2
通讯作者：
Domergue, J
中科院分区：
文献类型：
--
作者：
Navarro, F;Le Moine, MC;Domergue, J
Objective.本研究的目的是描述与保留下腔静脉的原位肝移植（奥尔特）相关的并发症及其治疗管理。这种保存技术在很大程度上影响了肝移植的手术阶段，增加了肝切除时间，改变了血管栓塞的数量。我们的回顾性多中心研究，根据1361例成人患者的数据，接受了原位肝移植与保留下腔静脉在法国1991年和1997年之间，分析了伴随的手术并发症。对下腔静脉-腔静脉吻合术的类型（背驮式、端侧式或侧侧式）、临时门腔静脉吻合术的使用、技术相关并发症和死亡率进行了研究。50.6%的病例（n=689）采用侧侧吻合，42.7%（n=582）采用背驮式吻合，6.6%（n=90）采用端侧吻合。总共进行了882次临时门腔静脉吻合术。55名患者出现了一种或多种与下腔静脉保留技术相关的并发症;即，总发病率为4.1%（55/1361），总死亡率为0.7%（10/1361），手术并发症患者的死亡率为18%。共记录了64例并发症：57例（89%）发生在围手术期或术后即刻，7例（11%）发生在术后。这些回顾性描述性结果显示，在血管并发症方面，侧侧吻合术具有显著优势。在移植前评估时应特别评估某些因素，以防止某些严重并发症;主要是受体的解剖因素（I段中包含的下腔静脉，下腔静脉的解剖异常）和移植物大小。根据这些因素，外科医生必须能够适应原位肝移植，无论是在原位肝移植之前还是在原位肝移植期间，首选标准技术。
Objective. The objective of this study was to describe the complications specifically related to orthotopic liver transplantation (OLT) with preservation of the inferior vena cava and to their therapeutic management. This preservation technique has considerably influenced the surgical phases of liver transplantation, increasing hepatectomy time and modifying the number of vascular anastomoses.Methods. Our retrospective multicentric study, based on data from 1361 adult patients that had undergone orthotopic liver transplantation with preservation of the inferior vena cava in France between 1991 and 1997, analyzed the concomitant surgical complications. Type of cavo-caval anastomosis performed (piggyback, end-to-side, or side-to-side), use of a temporary portacaval anastomosis, technique-related complications, and mortality, were investigated.Results. Cavo-caval anastomosis was side-to-side in 50.6% of cases (n=689), piggyback, in 42.7% (n=582), and end-to-side in 6.6% (n=90). In total, 882 temporary portacaval anastomosis were carried out. Fifty-five patients presented with one or more complications related to the preservation of the inferior vena cava technique; i.e., overall morbidity was 4.1% (55/1361), Overall mortality was 0.7% (10/1361), Mortality rate for patients who presented with surgical complication was 18%. A total of 64 complications were recorded: 57 (89%) were in the perioperative or immediate postoperative period and 7 (11%) were postoperative.Conclusions. These retrospective, descriptive results show significant advantages in favor of side-to-side anastomosis in terms of vascular complications. Certain factors should be evaluated specifically at pretransplant assessment to prevent certain serious complications; principally, these are anatomic factors of the recipient (inferior vena cava included in segment I, anatomic abnormalities of the inferior vena cava) and graft size. Depending on these factors, surgeons must be able to adapt the orthotopic liver transplantation, either before or during orthotopic liver transplantation, preferring the standard technique.