490 Autologous liver transplant surgery

The operation of autologous liver transplantation is very difficult.

In early surgery, the recent mortality rate after surgery is as high as 18.2% to 21.8%. Although surgical technology has been improved, the mortality rate during the surgery is still 4% to 9%, and the preservative hepatic ischemia and reperfusion syndrome is as high as 28.5% to 42%.

Retaining hepatic ischemia and reperfusion syndrome includes elevated leukocytes, coagulation dysfunction, high sodium, high potassium, liver dysfunction, acute renal injury, high graft loss, prolonged time for vasopressin after surgery, prolonged mechanical ventilation, prolonged residence time, and fatal small hepatic syndrome or preserving primary non-function of the liver occurs about 9% to 15.3%

Due to the high early mortality rate after autologous liver transplantation, the preservation of liver ischemia and reperfusion syndrome, the preservation of primary non-functional liver syndrome, the development of autologous liver transplantation technology is slow.

20     There are only hundreds of cases of this technology being reported over the years.

Su Yang actually had a clear understanding of the difficulty of autologous liver transplantation, so before the formal operation began, he did hundreds of exercises in the system space.

At this time, any patient came over and could carry out the operation with his eyes closed. His understanding of autologous liver transplant is no less than Fang Min!

The patient was ready before the operation and took a "human"-shaped incision into the abdomen.

Free the first hepatic portal hepatic artery (ha), portal vein (pv) and biliary tract, separate the second hepatic port, and expose the liver. The proximal and distal ends are used, and the organ removal or repair of surrounding tissues is performed according to the degree of invasion of the diaphragm, kidneys, etc.

After fully freeing the liver, place atrial and ear clamps on the upper and lower livers. Cut off the liver's inflow tract and outflow tract, and remove the liver completely.

After the entire liver is separated from the body, the liver repairing pelvis containing ice water in ℃ was immediately placed in a liver repairing pelvis containing –4   ℃. After the low-temperature organ preservation fluid was fully injected from pv                                                                                                                                                                                                                               

After the repair is completed, the weight and volume of the transplanted liver are weighed to further evaluate the "quality" and "quantity" of the transplanted liver.

During the period when the patient had no liver, another group of doctors temporarily reconstructed the posthepatic ivc with artificial blood vessels, and in parallel pv-ivc.

Select appropriate reconstruction methods based on the ha, pv and bile duct conditions after functional liver repair. The order of reconstruction intraoperatively is ivc, hepatic vein, pv, ha and bile tract.

If the normal autologous blood vessels removed from the ex vivo liver are not sufficient to reconstruct ivc, single and (or) bilateral saphenous veins of the patient can be used, or even artificial or allogeneic blood vessels can be replaced by ivc.

The patient was transferred to the liver transplant ward for treatment after the operation and undergoes a specialized color ultrasound in liver transplantation every day to monitor the degree of blood vessel patency, hemodynamics, etc. of the transplanted liver.

Su Yang is familiar with these details one by one.

Of course, in order to ensure that the operation is absolutely successful, he also did hundreds of exercises. It is no exaggeration to see what problems the patient will have during what period and what should he deal with.

"Cao Jian, movie." Su Yang stopped the movement in his hand and made a sound

“Where’s the location?”

“Eighth section, third quadrant, 15°23.”

Su Yang looked at it, then lowered his head and continued the operation.

"Cao Jia, take the microscope." After a while, Su Yang broke the silence.

Be accomplished?

The doctors standing on one side all jumped in their hearts.

During the operation just now, Su Yang used a microscope to anastomosis of the capillaries!

Autologous liver transplant?

Anastomosis of the capillary hepatic duct with a microscope?

When many doctors hear it, their scalp is numb!

That's not a job that humans do!

All operations are between a millimeter, completely beyond the concept of ordinary surgical procedures!

But Su Yang actually made it!

grass!

Do you want to hit people like this?

Among all, only Fang Min nodded with satisfaction.

Someone finally reached his height in the hepatobiliary surgery at the General Hospital. No... it is no longer reaching, but surpassing!

There are successors to the Department of Hepatobiliary Surgery in the General Hospital!

Fang Min was very satisfied.

"Old Fang, help me!" Su Yang's voice suddenly rang.

"Okay!" Fang Min nodded.

At this time, he had been standing on the stage for more than an hour, and finally had something to do! He began to assist Su Yang in the anastomosis of the blood vessels and liver ducts.

This is the last step of the surgery.

The portal vein flow is relieved and the autologous liver transplantation is over.

Vascular patch repairs the fracture end of the inferior vena cava, and Su Yangsong releases the vascular blocking forceps.

Allogeneic transplantation is like replacing the engine in a vehicle that stops driving, while autologous liver transplantation is replacing the engine in a vehicle that is driving, and it also ensures the normal driving of the vehicle. The technical difficulty can be seen.

Swish-

Everyone's eyes were projected on the patient's liver.

The retained liver is rosy in color and edema is slightly reduced.

The transplanted liver also began to perfusion, and during the period of time visible to the naked eye, only a little bleeding was seen in the two liver tissues.

The operation was successful!

Very perfect!

yeah--

Everyone couldn't help but shout in their hearts!

"Prepare hemostatic powder, hemostatic gauze, rinse."

Rinse the abdominal cavity, place drainage strips, sprinkle hemostatic powder on the wound of the liver, and cover it with absorbent hemostatic gauze.

Suture the diaphragm and check again. I saw that there was no active bleeding and I closed the abdomen.

After the operation was completed, the patient was carried onto the flat car and sent to the iCu with the airbag.

The applause finally rang.

Slut a sex!

Everyone gave Su Yang the applause without hesitation.

At this time, no one could deny that Su Yang's hepatobiliary surgery level had already reached the highest peak of the general hospital, and was already comparable to Fang Min. No, Fang Min was even more advanced.

Everyone was very excited.

But Su Yang did not dare to be careless.

Postoperative care for autologous liver transplantation is very important. Many patients will experience serious complications and will fail in the end. Therefore, at this time, the Long March has not been completed, and he still has a very critical part to walk.

After autologous liver transplantation, hemoglobin levels decline and blood pressure drop. When drainage tubes or abdominal cavity puncture fail to coagulate, you should be vigilant about abdominal bleeding.

In Su Yang's previous experimental treatment, there was one time. The patient had abdominal bleeding 4 days after the operation. He was given blood transfusion and pressure-enhancing drugs and other treatments. He was found to have continued bleeding in the intercostal artery, causing a large amount of hemorrhage in the abdominal cavity and the chest cavity. He was given hemostasis and blood transfusion, and hemorrhage was not stable. In the end, hemorrhage was ineffective and died.

Therefore, in addition to completely stopping hemoglobin, liver hilar and right adrenal area during the operation, the diaphragmatic blood vessels should not be underestimated.

In addition, he also encountered 1 time a patient died of cerebral hemorrhage, so for patients with neuropsychiatric symptoms such as confusion and speech disorder after the operation, in addition to considering liver failure and hepatic encephalopathy, intracranial complications must be ruled out.

In addition, there was another time when the patient developed hepatic venous outflow stenosis 3 months after the operation, showing a large amount of ascites, persistent hyponatremia, etc.
Chapter completed!