背景:活体同种异体肝移植是终末期肝病患者的外科治疗方法,其中健康的肝脏植入患者体内,促进终末期肝病患者肝功能的恢复。然而,原发性非功能(PNF)可能是该过程的结果。
方法:描述了一例65岁的亚洲男性,有肝硬化和肝细胞癌病史。肝门开放吻合术后发生顽固性低血压,大剂量的血管活性物质并没有改善病情。
方法:术中诊断为PNF,引起顽固性低血压。
方法:我们及时使用全门体分流术成功抢救。
结果:加强围手术期管理和积极治疗允许第二次肝移植和长达10小时的无肝期,随后病人获救。
结论:我们学到的教训是,全门体分流术与仔细的麻醉管理相结合可以挽救肝移植手术中PNF伴顽固性低血压的事件。同时,我们关注血压,心电图,白蛋白,钙,钾,酸中毒,凝血病,抗感染,和重要器官的保护对于成功的再移植结果至关重要。
BACKGROUND: Living donor allogeneic liver transplantation is a surgical treatment for patients with end-stage liver disease, wherein a healthy liver is implanted in the patient, facilitating the recovery of the liver function in patients with end-stage liver disease. However, primary nonfunction (PNF) may occur as a result of this procedure.
METHODS: A
case of an 65-year-old Asian male with a medical history of cirrhosis and hepatocellular carcinoma is described. Intractable hypotension occurred after open hepatic portal anastomosis, and large doses of vasoactive substances did not improve the condition.
METHODS: PNF was diagnosed during surgery and it caused intractable hypotension.
METHODS: we promptly used the total portosystemic shunt to achieve a successful rescue.
RESULTS: The strengthening of perioperative management and active treatment allowed second liver transplantation and anhepatic phase of up to 10 hours, following which the patient was rescued.
CONCLUSIONS: The lesson we have learned is that total portosystemic shunt composited with careful anesthesia management can rescue the event of PNF with intractable hypotension in liver transplantation surgery. At the same time, we give attention to blood pressure, electrocardiogram, albumin, calcium, potassium, acidosis, coagulopathy, anti-infection, and protection of vital organs is essential for successful retransplant outcomes.