tailieunhanh - Liver Transplantation - part 5

Độc tính: pH 50 giây và creatinine huyết thanh 3,4 mg / dL (300 mmol / L) trong các bệnh nhân với loại III hoặc IV bệnh não: lactate máu động mạch 3,5 mmol / l có liên quan với một tỷ lệ tử vong cao. Tất cả các nguyên nhân khác: prothrombin thời gian 50 giây (không phân biệt của bệnh não cấp) | The Liver Transplant Operation 45 Figure 2. Donor porta-hepatis. 5 The diaphragm is divided sagitally in front of the esophagus well to the left of the suprahepatic IVC. The right diaphragm is then divided well lateral to the right coronary ligament and continued towards the infrahepatic IVC. The IVC is transected above the renal veins and a suction catheter placed at this point. The CBD is completely transected and the peritoneum above the duodenum is incised to allow the duodenum to peel downwards. The right gastric artery is ligated and divided. The gastroduodenal artery GDA is exposed and followed to its origin from the hepatic artery. It is then ligated and divided away from the hepatic artery. see Fig. 2 The hepatic artery is followed proximally on its left side dividing the lymphatic and nervous tissue that overlies it here. The coronary vein will be seen and can be divided. It usually lies over the origin of the splenic artery which can be dissected for a centimeter or two and then transected once the celiac axis is clearly identified. The dissection is continued proximally along the left side of the celiac to the aorta. The length of supraceliac aorta is exposed on its left side by division of the crus of the diaphragm. The supraceliac aorta is transected at the level of the clamp and the aorta just to the left of the celiac incised and continued superiorly to the point of transection. The duodenum is now further mobilized away from the porta hepatis. And the tissue lateral to the portal vein is dissected toward the portal vein PV taking care to look for a replaced right hepatic artery. With the anterior surface of the vein exposed 46 Liver Transplantation 5 the pancreas is split at the neck to expose the portal vein origin. The superior mesenteric and splenic veins are then transected. The portal vein segment is passed beneath the duodenum to lie with the other hepatic structures. If there is no replaced right hepatic artery the nerves and lymphatic .