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摘要:
目的 总结婴幼儿活体肝移植和劈离式肝移植供体手术方式的区别以及手术配合体会。 方法 2006年9月至2013年12月,上海交通大学医学院附属仁济医院实施婴幼儿肝移植200例,其中活体肝移植170例,劈离式肝移植30例。收集活体肝移植和劈离式肝移植供体获取的手术资料,总结分析两种术式的术前准备(人员准备和器械准备)、术中配合、手术时间的差异。 结果 与劈离式肝移植供体获取比较,活体肝移植供体获取的手术操作较为复杂,参与手术的人员与所需特殊器械和物品相应较多。活体肝移植供体手术为在体劈离,分别离断肝动脉左支、门静脉左侧主干及在肝左静脉汇入下腔静脉处离断肝左静脉。劈离式肝移植供体获取则在体外修肝盆中完成,手术方式与活体肝移植类似。活体肝移植组供体手术组的手术时间为(4.3±0.2)h,劈离式肝移植组供体手术则为(1.6±0.2)h,两组比较差异具有统计学意义(P<0.05)。 结论 活体肝移植和劈离式肝移植两种婴幼儿肝移植的手术方式有所区别。与劈离式肝移植供体获取比较,活体肝移植术供体获取手术所需工作人员、特殊器械和物品的数量较多,手术时间较长。因此,所有参与手术的人员均应密切配合,手术过程中要求护理人员尤其需要有极强的无菌观念、动作敏捷、熟练掌握肝移植术的配合过程。 -
表 1 活体(亲体)肝移植与劈离式肝移植供体手术的人员配置
Table 1. Personnel allocation in living donor liver transplantation and splitting liver transplantation(n)
人 员 活体肝移植供体手术 劈离式肝移植供体手术 手术护士 1 1 巡回护士 2 1 手术医师 4 2 麻醉师 2 0 合计 9 4 表 2 活体肝移植与劈离式肝移植供体手术的特殊器械和物品准备
Table 2. Preparation of special equipment and items in the donor surgery of living donor liver transplantation and splitting liver transplantation (n)
手术方式 活体(亲体) 肝移植供体手术 劈离式肝移植 供体手术 超声吸引刀(台) 1 0 床旁超声仪(台) 1 0 专用拉钩(套) 2 0 器官保存液(袋) 2 0 修肝专用工作台(个) 0 1 合计 6 1 -
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