摘要:目的:探討床旁超聲檢查在肝移植術后下腔靜脈(IVC)并發癥診斷中的應用價值。方法:對424例肝移植術后患者進行床旁超聲檢查,對下腔靜脈并發癥,包括狹窄及栓塞的資料進行回顧性分析和總結。結果:床旁超聲檢查發現下腔靜脈并發癥患者18例,其中狹窄6例,栓塞12例。結論:床旁超聲檢查在肝移植術后,尤其是對術后早期發生的下腔靜脈并發癥的診斷及監測具有重要的作用,為臨床診斷和治療提供及時、有價值的影像學依據。Abstract: Objective: To evaluate the value of bedside ultrasound in diagnosis and monitoring of inferior vena cava (IVC) complications after liver transplantation. Methods: 424 cases with liver transplantation were examined by bedside ultrasound after the operations. The results of IVC complications,including thrombosis and stenosis, were analyzed and summarized. Results: 18 cases with IVC complications were detected by bedside ultrasound, including 6 cases of stenosis and 12 cases of thrombosis. Conclusion: Bedside ultrasound is important for diagnosing and monitoring IVC thrombosis and stenosis after liver transplantation, especially in the earlier period. It could provide valuable imaging for clinical diagnosis and treatment promptly.
Objective To investigate the surgical technique of reduced sized liver transplantation. Methods A reduced size liver transplantation was successfully performed on a 11-year old girl with incurable caroli′s disease. Results The recovery of liver graft function was good after the operation in this patients without complications. Conclusion Reduced size liver transplantation is a safe and effective technique for pediatric liver transplantation to provide liver graft. Authors introduced their experiences of surgical technique in this patient.
ObjectiveTo explore risk factors of blood transfusion during liver transplantation and construct its prediction model. MethodsThe patients underwent liver transplantation who met the inclusion and exclusion criteria of this study from March 2020 to December 2020 in the Beijing Youan Hospital of Capital Medical University were retrospectively collected. The univariate and logistic multivariate analysis were used to evaluate the risk factors of blood transfusion during liver transplantation and construct the prediction model for intraoperative blood transfusion. ResultsA total of 151 eligible liver transplantation patients were collected in this study, including 51 non-transfusion patients and 100 transfusion patients. The univariate analysis results showed that the differences of primary diagnosis, preoperative hemoglobin (Hb), platelet count, prothrombin time, international normalized ratio, Child-Turcotte-Pugh score, and end-stage liver disease (MELD) score were statistically different between them (P<0.05). The above variables selected by the univariate analysis were selected by stepwise method, then the preoperative Hb and MELD score were selected into the multivariate logistic regression analysis, the results showed that the preoperative Hb≤113 g/L and MELD score ＞14 increased the risk of blood transfusion during liver transplantation [Hb: OR=6.652, 95%CI (2.282, 19.392), P<0.001; MELD score: OR=16.037, 95%CI (6.336, 40.592), P<0.001]. The logistic regression model predicted the area under receiver operating characteristic curve was 0.873 [95%CI (0.808, 0.919), P<0.001], the sensitivity and specificity were 91.0% and 67.5%, respectively, Youden index was 0.674, the accuracy was 86.1%. ConclusionsResults of this study suggest that preoperative Hb ≤113 g/L and MELD score＞14 increase risk of blood transfusion during liver transplantation. Logistic regression model constructed according to preoperative Hb and MELD score has a better sensitivity and specificity of intraoperative blood transfusion.
Objective To observe the recovery of recipients with complex portal vein thrombosis (CPVT) underwent “multiple to one” anastomosis and patency of portal vein blood flow during liver transplantation, and to ensure the reliability of this method. MethodsThe clinicopathologic data of the recipients with CPVT underwent “multiple to one” anastomosis in the Beijing Friendship Hospital, Capital Medical University were collected retrospectively. The “multiple to one” portal vein reconstruction was defined as the anastomosis of multiple vessels of portal venous system with the portal vein of graft, or the anastomosis that connected the blood vessel of portal venous system and the left renal vein/inferior vena cava to the portal vein of graft. ResultsA total of 5 patients were collected, including 1 patient with Yerdel grade 3 thrombosis and 4 patients with Yerdel grade 4 thrombosis. In 3 cases, the left renal vein, inferior vena cava, left renal vein were combined with the parabiliary vein, respectively, in the anastomosis to the donor portal vein. In another 2 cases, portal vein and left renal vein were combined with gastric coronary vein, respectively, in the anastomosis to the donor portal vein. During the follow-up period of 162–865 d, all patients had the stable portal vein blood flow without any symptom of portal hypertension. One patient had thrombosis at the anastomosis with varicose vein, while the anastomosis with left renal vein was unobstructed, which did not affect the donor liver function. ConclusionMultiple blood supply of portal vein is established after “multiple to one” anastomosis, and stability of portal vein blood flow can be maintained after a blood redistribution of portal venous system following liver transplantation.
【Abstract】Objective To discuss the application of endoscopic diagnosis and treatment of biliary stone with choledochofiberscope after orthotopic liver transplantation.Methods Five patients with repeated infection of bile duct and obstructive jaundice were treated with choledochofiberscope through T tube sinus, combining with the plasma shock wave lithotripsy, the eyewinker clam and the basket extraction. Results We could efficiently extract the biliary tract stone through choledochofiberscope combining with plasma shock wave lithotripsy, eyewinker clam and basket extraction; and observe the healing appearance, and blood circulation of the biliary tract. Conclusion The choledochofiberscope can be used to diagnose and treat biliary tract stone of orthotopic liver transplantation. The choledochofiberscope and T tube will be important in diagnosis and treatment of biliary tract stone following orthotopic liver transplantation.
ObjectiveTo evaluate the application of portosystemic shunt after subcutaneous transposition of the spleen (STS) to orthotopic liver transplantation (OLT) in the rat. MethodsOne hundred and eighty Wistar rats were randomly divided into the group of orthotopic liver transplantation after portosystemic shunts by subcutaneous transposition of the spleen (STS+OLT group) and the group of orthotopic liver transplantation (OLT group). The two groups were further divided into A, B, C subgroups in the light of duration of anhepatic phase (phases were respectively less than 25 min, around 35 min and 45 min).There were fifteen rats in each subgroup. At the described intervals, blood samples were collected from the peripheral and portal vein for testing ALT, pH and endotoxin levels. The survival rates were also observed. Results The ALT value of all animals basically returned to normal levels on the 7th postoperative day in the STS+OLT group and the OLT A subgroup, but in OLT B subgroup, ALT was still remarkably elevated on the 7th postoperative day (P＜0.01), and returned to normal levels on the 30th postoperative day. The pH values and endotoxin levels from the portal vein of all animals in STS+OLT groups and OLT A subgroup had no significant difference (Pgt;0.05) at the beginning, the end of the anhepatic phase and at the time of reperfusion for 30 min. But in the OLT B and C groups, the pH values and endotoxin levels were significantly higher at the end of anhepatic phase and reperfusion for 30 min than those in the beginning of anhepatic phase (P＜0.01). The survival rates at postoperative different time points in both B and C subgroup of the OLT group were significantly lower than those in STS+OLT group animals (P＜0.05).Conclusion The portosystemic shunt by subcutaneous transposition of the spleen can notably improve both the success rate of the OLT procedure and the postoperative survival rate in the rat.
Objective To introduce the mechanisms of graft injuries after small-for-size liver transplantation and protective measures. Methods Recently relevant literatures were reviewed and summarized. Results Portal hypertension after small-for-size liver transplantation induces mechanical injuries as well as hepatic sinusoidal microcirculation disturbance and cytokines release, which worsened the injuries. Decrease portal pressure by surgery or drug could improve grafts function. ConclusionComprehending the mechanisms of graft injuries will contribute a lot for the living donor liver transplantation.
ObjectiveTo investigate the association between preoperative systemic immune-inflammation index (SII) and early allograft dysfunction (EAD) in liver transplant recipients. MethodsThe patients underwent liver transplantation who met the inclusion and exclusion criteria in the West China Hospital of Sichuan University from January 2015 to December 2019 were collected. The postoperative EAD was analyzed. The generalized propensity score weighting (GPSW) were used to balance the confounding factors affecting the occurrence of EAD. ResultsA total of 390 patients who met the inclusion and exclusion criteria were enrolled in this study, 93 cases of EAD occurred, the incidence of EAD was 23.8%. The recipient’s model for endstage liver disease score and Child-Pugh grade, the donor’s body mass index, age, and graft weight, and the intraoperative cold ischemia time, liver transplantation time, intraoperative blood loss, total infusion, red blood cell transfusion, autologous blood reinfusion, fresh frozen plasma transfusion, concentrated platelet transfusion, total red blood cell and autologous blood transfusions were balanced by GPSW, then the overall mean correlation coefficient of the 14 covariables and SII decreased from 0.049 to 0.039, and each covariable reached the standard of less than 0.1. The binary logistic regression analysis based on GPSW showed that there was no significant association between SII and EAD (P=0.371). ConclusionFrom preliminary result of this study, it is not found that preoperative SII of liver transplantation patients is related to occurrence of postoperative EAD.
Objective To evaluate safety and long-term efficacy of fully covered self-expandable mental stent (FCSEMS) in treatment of biliary stricture after liver transplantation (LT). Methods From January 2010 to June 2018, the data of patients with the biliary stricture after the LT underwent the endoscopic retrograde cholangiagraphy (ERCP) at the First Hospital of Lanzhou University were collected retrospectively. The therapeutic effect of the FCSEMS was evaluated. Results A total of 21 patients with the biliary stricture after the LT were treated. The success rate of the stent placement was 100%. The FCSEMSs were used in 7 cases and the only multiple plastic stents (MPSs) were used in 14 cases. There were no significant differences in the gender, age, time of biliary stricture, frequency of ERCP, recurrence time of biliary stricture, cure time of biliary stricture, curative effect, recurrence of biliary stricture, and incidence of complications between the patients treated with the FCSEMS and the MPS (P>0.050), but the number of plastic stents in the patients treated with the FCSEMS was significantly less than that in the patients treated only with the plastic stents (P<0.050), while the duration of stent retention was longer than that in the patients treated only with the plastic stents (P<0.050). Six patients were cured, 1 was remitted, and 2 were relapsed by the FCSEMS. Eight were cured, 3 were remitted, 3 were ineffective, and 5 were relapsed by the MPS alone. Conclusions FCSEMS might be an safe effective alternative to plastic stent in treatment of biliary stricture after LT, resulting in a longer duration placement, less number of plastic stent use. It is necessary to further accumulate cases to validate cure rate and recurrence rate of biliary stricture.
Objective To investigate the effect on expression regulation of calmodulin-dependent kinases casades (CaMK) Ⅱ on liver function after liver transplantation in rats. Methods Allogeneic orthotopic liver transplantation model was established by using the classic two-cuff method. The lentiviral expression systems of CaMKⅡγ protein and CaMKⅡγ shRNA were constructed. The lentiviral vector expressing CaMKⅡγ shRNA and the lentiviral vector expressing CaMKⅡγ protein were perfused into the rat after liver transplantation respectively, and the corresponding blank vector and normal saline were perfused into the control group at the same time. The serum levels of ALT and AST were measured at different time points of inferior vena cava blood in rats. Results The serum ALT and AST levels were debased in the after transplantation rats whose lentiviral vector expressing CaMKⅡγ shRNA (P<0.05). The serum ALT and AST levels were raised in the after transplantation rats whose lentiviral vector expressing CaMKⅡγ protein (P<0.05). There were no significant difference of serum ALT and AST levels between the blank control group and the saline group (P>0.05). Conclusion Specific blocking of CaMK Ⅱ signaling pathway can effectively reduce the serum ALT and AST levels after liver transplantation in rats, and enhanced CaMK Ⅱ signaling pathway increases the serum ALT and AST levels after liver transplantation in rats.