摘要
目的观察猪活体肾移植手术中腹腔镜手术对移植肾缺血再灌注损伤的影响。方法用猪同种肾移植模型(白色小型猪CEMP-Ⅲ黑色小型猪CEMP-Ⅰ),分腹腔镜组和开放手术组活体取肾。移植后1、3 d观察移植肾组织学分析了解缺血再灌注损伤的程度,实时荧光定量聚合酶链反应(PCR)检测TLR4(Toll-like receptor)mRNA的表达了解导致缺血再灌注损伤差异的机制。结果组织学分析发现移植后1 d两组移植肾以肾小管浊肿为主,移植后3 d腹腔镜组移植肾肾小管多见片状坏死,而开放手术组仅见肾小管浊肿和局灶性坏死;检测移植肾中TLR4 mRNA表达,发现移植后第1天两组TLR4 mRNA表达指数差异无统计学意义(11.93±3.66比12.46±2.60,P>0.05),移植后第3天两组TLR4 mRNA表达指数差异有统计学意义(30.16±6.19比61.53±9.47,P<0.01)。结论腹腔镜活体取肾手术中CO_2气腹引起腹内压增加影响供肾血流,导致早期移植肾有加重缺血再灌注损伤的风险,TLR4表达增加可能发挥重要作用。
Objective To evaluate the effects of laparoscopic live donor nephrectomy on ischemi- a-reperfusion injury after pig kidney transplantation. Methods The pig kidney transplantation models was established （miniature swine CEMP-Ⅲ kidney to miniature swine CEMP-Ⅲ ）. All the animals were divided into 2 groups ： open and laparoseopie living donor nephreetomy group. Isehemia-reperfusion injury was analyzed on posttransplantation day 1 and 3 by histology. Difference of isehemia-reperfusion injury was e- valuated in terms of the expression of toll-like receptor 4 （TLR4） mRNA detected quantitatively by realtime RT-PCR. Results Light microscopy （LM） revealed granular degeneration of the epithelial cells in the renal tubules of both open and laparoseopy groups. Local necrosis was observed in some tubular epithe- lial cells of kidney of open group, while extensive necrosis in those of laparoseopy group. Compared with open group, no difference in TLR4 mRNA in laparoseopy group was detected on day 1 （ 11.93 ± 3.66 vs 12.46 ± 2.60 ,P 〉 0.05 ）. However, the expression of TLR4 mRNA in laparoseopy group, as compared to open group, was significantly increased on day 3 （30.16 ± 6.19 vs 61.53 ± 9.47, n = 4, P 〈 0.01 ）. Conduslon The increased intraabdominal pressure secondary to CO2 pneumoperitoneum during laparoseopie live donor nephreetomy affects the blood supply of the donor kidney, resulting in suffering augmenting isehemia-reperfusion injury. The increased expression of TLR4 mRNA in kidneys harvested by laparoseopy after transplantation maybe play a great role in the augmentation of ischemia-reperfusion injury.
出处
《中华实验外科杂志》
CAS
CSCD
北大核心
2007年第11期1374-1375,共2页
Chinese Journal of Experimental Surgery
基金
山东省自然科学基金(30200272)
关键词
TOLL样受体
缺血
再灌注损伤
腹腔镜
肾切除
肾移植
Toll-like receptor
Ischemia
Reperfusion injury
laparoscopy
Nephrecto-my
Renal transplantation
