计划性体外膜氧合辅助下肝移植3例  

Planned initiation of extracorporeal membrane oxygenation prior to liver transplantation:a report of 3 cases

作　　者：王子岳 陶慧超[1] 孙晓东[1] 邱伟[1] 陈玉国[1] 黄鹤宇 刘大群 吕国悦[1] Wang Ziyue;Tao Huichao;Sun Xiaodong;Qiu Wei;Chen Yuguo;Huang Heyu;Liu Daqun;Lyu Guoyue(Department of Hepatobiliary Pancreatic Surgery,First Hospital,Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学第一医院肝胆胰外科,长春130021

出　　处：《中华器官移植杂志》2022年第4期224-227,共4页Chinese Journal of Organ Transplantation

基　　金：吉林省财务厅项目(JLSCZD2019-036)。

摘　　要：目的探究肝移植术中计划性应用体外膜氧合(ECMO)的可行性及优势。方法回顾性分析2017年11月至2021年7月吉林大学第一医院收治的3例ECMO辅助下肝移植受者的临床资料。3例受者术前均出现不同程度乏力、胸闷、心悸等右心功能不全表现。1例因受者拒绝,术前未行右心导管检查,另2例受者经胸多普勒超声心动图(TDE)筛查,右心导管检查分别确诊为门脉性肺动脉高压和毛细血管后性肺动脉高压。结果3例合并肺动脉高压受者均在患肝游离后即下腔静脉阻断前,于右侧股动脉及股静脉置管,行动脉-静脉ECMO支持,根据全血凝血时间调整肝素用量,围手术期生命体征平稳。3例受者呼吸机支持时间分别为54、12、62 h,ECMO支持时间分别为27、61、14 h,均顺利出院,随访时间为26(9~52)个月,肝功能正常。结论合并肺动脉高压的终末期肝病患者肝移植术前等待期间应常规行TDE检查,提示肺动脉压高压患者,应进一步行右心导管检查明确诊断及疾病严重程度分级。经多学科会诊有计划的应用ECMO,可扩大肝移植的手术适应证,维持术中血流动力学稳定,对肝移植手术的顺利进行和受者术后康复均起到重要作用。Objective To explore the feasibility and advantages of planned initiation of extracorporeal membrane oxygenation(ECMO)prior to liver transplantation.Methods From November 2017 to July 2021,clinical data were retrospectively reviewed for 3 liver transplantation recipients assisted by ECMO.There were such preoperative symptoms of right ventricular dysfunction as fatigue,chest tightness and palpitations.In the first case,right heart catheterization was not performed due to patient refusal;another two patients were screened by transthoracic Doppler echocardiography(TDE)and diagnosed through right heart catheterization as portopulmonary hypertension(POPH)and pulmonary hypertension.Results Three recipients with pulmonary hypertension received catheterization in right femoral artery and vein.After freeing of diseased liver and before blocking inferior vena cava,V-A ECMO support was performed.The dose of heparin was adjusted according to activated clotting time(ACT)and perioperative vital signs remained stable.They were ventilated for 54,12 and 62 hours and supported by ECMO for 27,61 and 14 hours.All were smoothly discharged.During a mean follow-up period of 26(9-22)months,liver functions were normal.Conclusions Patients with end-stage liver disease with pulmonary hypertension should undergo routine TDE examinations during waiting period before liver transplantation.Those with pulmonary hypertension should undergo further right heart catheterization to confirm the diagnosis and severity of the disease.Planned application of ECMO through multidisciplinary consultations can expand surgical indications for liver transplantation,maintain intraoperative hemodynamic stability and facilitate smooth liver transplantation and postoperative patient recovery.

关 键 词：肝移植 体外膜氧合 肺动脉高压 血流动力学 

分 类 号：R657.3[医药卫生—外科学]