Piggyback allogeneic orthotopic liver transplantation was performed successfully in a patient with primary biliary cirrhosis on July 26,1996. Topographic study of hepatic veins and short hepatic veins were made in 17 adult cadavers. The majority of short hepatic veins were found in the middle and lower portion of inferior vena cava (IVC) behind liver, but two of 17 cases had a big accessory middle hepatic vein and the right hepatic vein (1 case) divided four branchs into IVC in the area. The lengths of the main trunk of left, middle and right hepatic vein were 22.8±8.80 mm, 50.98±23.94 mm and 22.80±9.50 mm and the diameters were 10.74±2.86 mm, 9.50±3.75 mm and 15.60±4.05 mm respectively. The right hepatic vein in all cases, except one drained into IVC as one vessel. The middle and left hepatic vein drained into IVC in different forms: ①joining as one vessel longer than 1cm before entering IVC (23.5%);②joining right before entering IVC (70.6%); ③draining into IVC separately (5.9%). The distance between right and middle hepatic vein was 7-23 mm. Topography of hepatic veinous flow related with the technique of piggyback operation and removing of diseased liver is discussed.
Objective To investigate the joint effects of selective digestive decontamination (SDD) and glutamine (Gln) on preventing intestinal bacterial translocation of orthotopic piggyback liver transplantation and to observe the incidence of postoperative pneumonia in rabbit. Methods Thirty rabbits received orthotopic piggyback liver transplantation and were randomly divided into three groups (SDD group, SDD+Gln group and control group). Mixed emulsion of tobramycin, polymyxin E and nystatin were given to the rabbits in SDD group. Same dosage of the above components plus Gln were given to the rabbits in SDD+Gln group. Samples of portal vein blood, ileum tissue and lung tissue were obtained in each group at different phases during and after operation, the pathological changes of ileum tissue, the bacterial translocation in blood of portal vein and the incidence of postoperative pneumonia were detected. Results The mixing section area of intestinal blood capillaries in SDD+Gln group was smaller compared with control group (P＜0.05， P＜0.01) and SDD group (P＜0.05) while the portal vein was obstructed for 15, 30 and 45 min, and after the operation, respectively. The length of ileum villus in SDD+Gln group was longer than that in control group (P＜0.05) and in SDD group (P＜0.05) before the portal vein was obstructed, but the length of ileum villus in control group gradually became longer and eventually exceeded that in SDD+Gln group at the time of 45 min after the portal vein was obstructed (P＜0.05). After the operation, the length of ileum villus in SDD+Gln group was significantly longer than that in SDD group (P＜0.05) and control group (P＜0.01). At the time of 45 min after the obstruction of portal vein and 30 hours after operation, the positive rate of cultured bacterial in the blood of portal vein in SDD+Gln group was significantly lower than that in control group (P＜0.05, P＜0.01). The incidence of postoperative pneumonia in SDD+Gln group and SDD group were significantly lower than that in control group (P＜0.05,P＜0.01). Conclusion Gln could nourish intestinal epithelium of mucous membrane.When combined with SDD, it could decreased the incidence of intestinal bacterial translocation occurred during the obstruction of portal vein and after operation, so as to decrease the incidence of postoperative pneumonia.
【摘要】目的 总结分析原位背驮式肝移植手术后并发症与供肝修整的关系。方法 回顾性分析我院12例行原位背驮式同种异体肝移植患者的资料。结果 本组12例肝移植围手术期无死亡； 手术成功率为100%。12例中行动脉血管变异整形2例，门静脉搭桥吻合1例； 各韧带修剪后缝合7例，未缝合5例。手术后发生腹腔内出血3例，其中2例与供肝修整有关，即修肝时各韧带未仔细缝合及结扎而导致细小血管出血，另1例系凝血功能障碍所致； 在供肝修整中注意了血管的变异整形及胆管的血供，术后无动脉及门静脉血管并发症和胆道并发症发生。结论 修肝质量的好坏，直接关系到术中植肝时手术操作的难度、术后供肝的存活质量、并发症的发生和患者的康复。