ABSTRACT
Objective To investigate the application of molecular absorbent recycling system (MARS) in auto liver transplantation (ALT).Methods The clinical data of 46 patients who underwent ALT in Zhongnan Hospital of Wuhan University from September 2014 to August 2015 were retrospectively studied.The patients were randomly divided into the MARS group (n =30) and the hemodialysis group (n =16).In the MARS group,20 patients were male and 10 were female with an average age of (15 ±67) years,and the median age was 46.In the hemodialysis group,8 were male and 8 were female with an average age of (22 ± 54) years.A heparinized left iliac vein was linked to a centrifugal pump of a MARS and an output tube was linked to a left jugular vein.Before the anhepatic phase,physical pretreatment was carried out by ligating the porta hepatis and inferior vena cava (IVC) to adapt the patient to the anhepatic phase.Subsequently,a bypass was established followed by ligation of the IVC.The duration of operation,length of stay in ICU after operation,one-year survival rate and hepatorenal function were studied.Results The duration of operation in the MRAS group and in the hemodialysis group was not significantly different (P ＞0.05).The length of stay in ICU after operation in the MARS group was (12.0 ±3.0) d,which was significantly shorter than that of the hemodialysis group (20.0 ± 2.0) d (P ＜ 0.05).The one-year survival rate in the MARS group was (100％),which was significantly higher than that of the hemodialysis group (93.8％,P ＜0.05).Conclusion The application of MARS in ALT shortened the length of stay in hospital and improved one-year survival rate,resulting in better outcomes than the conventional method.
ABSTRACT
Auto liver transplantation (ALT) is a treatment option for patients with liver space-occupying lesion that could not be removed by conventional surgery and severe liver trauma,which also helps alleviate the shortage of donor liver.But many problems like the preoperative assessment,the tolerance of patients to surgery and anesthesia,delayed postoperative recovery of the liver function,primary non-function,liver failure and hepatic encephalopathy and even death still need to be addressed.Thus,it is particularly important to evaluate the operative indication,completely and accurately assess the preoperative liver function and liver function reserve,and reduce the perioperative mortality and complication in order to improve the prognosis of ALT.Combined with literalure and the experience in our center,this paper summarized the research advance of preoperative assessment in patients with ALT.
ABSTRACT
Auto liver transplantation (ALT) has been tremendously popular in hepatic surgery for the liver masses due to lack of enough donor for allogeneic transplantation of liver.But ALT remains stagnant because it is technically more difficult than liver transplantation.Much difficulties in this field lying ahead.Related surgical technical requirements for surgeons operating ALT,complications,difficult liver resection,hypothermic liver perfusion,veno-venous bypass,ex vivo ECMO perfusion and liver trim,assess the quality and volume of autoplast,autoplast implant and vascular anastomosis.On the other hand,the therapeutic effect largely depends on the intraoperative vascular separating range,the location and size of the tumor,the scope of lymphoid infiltrates by neoplast,the intubation site for perfusion and the sequence of opening the occlusion vessel.Thus,it's necessary to set up a scientific,normative ALT procedure to improve the therapeutic effect and prognosis.