Percutaneous large bore cannula placement during orthotopic liver transplantation (OLT) for use in venovenous bypass (VVB) has been reported to be a rapid and simple technique. It is, however, a technique that carries its own risks. The aim of the study was to investigate the incidence of complications related to the placement of a percutaneous venous return cannula and subsequent VVB in OLT. A retrospective review of 360 consecutive adult OLT patients during a period of 18 months (January 1, 2003 to June 30, 2004) was performed. The percutaneous venous cannula (18 Fr) was placed by an attending transplant anesthesiologist. The cannulation was attempted in 326 patients (90.6%). No cannulation was attempted on the subclavian veins. Internal jugular venous cannula placement was attempted but aborted in 6 patients (1.8%) due to technical difficulties. In 320 patients who received an internal jugular venous cannula, 313 (97.8%) underwent OLT without complication. The remaining 7 patients (2.2%) had complications. The operation was delayed for 1 patient due to suspected hemomediastinum. The other 6 complications were related to VVB: air embolism (2 patients), low flow rate (2 patients), hypotension (1 patient), and atrial fibrillation (1 patient). Successful OLT was eventually carried out in all the 7 patients and no mortality associated with internal jugular venous cannula placement or VVB was noted. In conclusion, percutaneous placement of a large bore venous return cannula for VVB during adult OLT can be performed with acceptable risk using a flexible 18-Fr cannula via the right internal jugular vein (IJV) by experienced attending transplant anesthesiologists.

译文

据报道,在原位肝移植 (OLT) 中用于静脉旁路 (VVB) 的经皮大口径套管放置是一种快速而简单的技术。然而,这是一种自担风险的技术。该研究的目的是调查与OLT中经皮静脉回流套管和随后的VVB放置有关的并发症的发生率。对18个月 (2003年1月1日2004年6月30日) 的360例成人OLT患者进行了回顾性研究。由主治的移植麻醉师放置经皮静脉插管 (18 Fr)。在326例患者中尝试插管 (90.6%)。未尝试对锁骨下静脉进行插管。尝试放置颈内静脉插管,但由于技术困难而中止了6例 (1.8%)。在接受颈内静脉插管的320例患者中,313 (97.8%) 接受了OLT,没有并发症。其余7名患者 (2.2%) 有并发症。1例患者因怀疑有纵隔血而延迟手术。其他6种并发症与VVB有关: 空气栓塞 (2例),低流速 (2例),低血压 (1例) 和房颤 (1例)。最终在所有7例患者中成功进行了OLT,没有发现与颈内静脉插管或VVB相关的死亡率。总之,经验丰富的主治移植麻醉师可以通过右颈内静脉 (IJV) 使用柔性18-fr套管在成人OLT期间经皮放置VVB大口径静脉回流套管,风险可接受。

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