PDF(Pubmed)
Abstract：
Venovenous bypass (VVB) is a technique used in liver transplantation (LT) to maintain hemodynamic stability and abdominal organ perfusion and thereby improve patient outcomes. Despite its perceived benefits, VVB utilization has declined globally due to concerns related to heparinization, major bleeding and the need for expertise. Recent advancements, such as percutaneous cannulation techniques and improved extracorporeal technology have improved the safety of VVB in LT. This paper presents a modified VVB circuit with enhanced safety features. Cannulation plays a pivotal role in VVB establishment, with percutaneous methods increasingly favored. Studies demonstrate VVB\'s efficacy in improving patient outcomes with lower incidence of acute kidney injury and reduced operative time and blood loss, with no added morbidity or mortality. However, its routine use faces challenges, with alternative techniques gaining traction. Our experience highlights VVB\'s role in various clinical scenarios, including patients with high Model for End-Stage Liver Disease (MELD) scores, challenging surgical anatomy, portal vein thrombosis and pre-existing cardiovascular disease, emphasizing its safety and efficacy. Continued research is needed to optimize VVB techniques and ensure better outcomes for liver transplant recipients.
摘要：
静脉转流（VVB）是一种用于肝移植（LT）的技术，用于维持血液动力学稳定性和腹部器官灌注，从而改善患者的预后。尽管它有明显的好处，由于与肝素化有关的担忧，全球VVB利用率下降，大出血和需要专业知识。最近的进步，如经皮插管技术和改进的体外技术提高了LT中VVB的安全性。本文介绍了一种改进的VVB电路，具有增强的安全性。插管在VVB建立中起着举足轻重的作用，随着经皮方法越来越受到青睐。研究表明，VVB在改善患者预后方面的功效，降低急性肾损伤的发生率，减少手术时间和失血量，没有增加发病率或死亡率。然而,它的常规使用面临挑战，替代技术获得了牵引力。我们的经验强调了VVB在各种临床场景中的作用，包括终末期肝病模型（MELD）评分高的患者，具有挑战性的外科解剖学，门静脉血栓形成和预先存在的心血管疾病，强调其安全性和有效性。需要继续研究以优化VVB技术并确保肝移植受者的更好结果。
