摘要
目的:建立一种新的猪辅助性部分原位肝移植模型,并对其血流动力学变化进行观察。方法:选用健康良种幼猪16只,随机配成8对,基础麻醉加气管插管静脉复合麻醉。手术方法:切去供肝左叶,将留存之右叶供肝作移植肝。切除受体之肝左外叶,将右叶供肝肝上、下腔静脉与受肝肝上、下腔静脉行端侧吻合,供肝门静脉与受肝门静脉行端侧吻合,受体脾动脉在结肠后与供体肝动脉行端端吻合,胆总管置管外引流。术中热缺血时间为0min,冷缺血时间为(58±4.0)min。切肝前10min、全肝阻断后10min、供肝植入开放门静脉后10min分别取血检测电解质和全血缓冲碱(BB)及标准碳酸氢根浓度(SB),并观察各个时期的心率(HR)、平均动脉压(MAP)和中心静脉压(CVP)。术后常规处理,未用抗排斥药。部分存活猪在术后5d彩超观察门静脉血流,同时行病理切片检查。结果用均数±标准差表示,采用方差分析和q检验。结果:手术成功率87.5%。术中、术后血流动力学和生化指标均告平稳。术后5d,部分猪彩超结果显示门静脉无血栓形成,仅见移植肝断面有少量包裹性积液,移植肝门静脉最大流速为42.2cm/s,受体肝及移植肝门静脉血流均告通畅。活杀大体及病理切片观察,移植肝形态色泽正常,各吻合口无扭曲、漏血和血栓形成,门静脉无血栓形成。术后5d。
Objective: To observe the intraoperative hemodynamic changes and graft function in a new pig model of auxiliary partial orthotopic liver transplantation. Methods: Sixteen healthy male or female domestic pigs, weighing 22 to 27 kg, were randomly selected to be either a donor (n=8) or a recipient(n=8). After intubation, anesthesia was maintained by pentothal sodium. The left lobe of the donor liver was resected in vitro, the right lobe was used as a graft. Donor suprahepatic inferior vena cava was anastomosed end-to-side to host suprahepatic inferior vena cava, donor portal vein end-to-side to host portal vein, donor hepatic artery end-to-end to host spleen artery. The common bile duct of the donor was intubated and bile was collected with an extracorporeal bag. At the end of operation, the donor's infrahepatic inferior vena cava was ligated. Cold ischemia time averaged about (58±4.0) min. Immunosuppressants were not administered and antibiotics were administered for three days after operation. During transplantation, arterial blood pressure, central venous pressure were monitored. BB, SB and pH of arterial blood samples were determined and analysed in order to assess the impact of operation on the animals. Color ultrasound examinations were performed 5 days after operation in some recipients and autopsy was made on all the recipients. Wedge biopsy specimens of every pig was obtained and stained with hematoxylin-eosin. Results: Seven of the 8 recipients (87.5%) survived for five days, one recipient did not recover from anesthesia, probably due to hyperkalemia and severe acidosis. The hemodynamis recovered rapidly and stabilized after graft reperfusion. Color ultrasound examination showed an increase of blood flow of graft on the 5th day compared to the 1st day after operation. When the animals were sacrificed on the 5th day after operation, thrombosis of HV and PV were not found; histopathological examination of liver specimens revealed evidence of damage with mild steatosis and sporadic necrotic foci and focal hepatic lobules degeneration in the graft,especially around the pericentral venous area. Infiltration by inflammatory cells was mild in the portal or central veinous area. Conclusions: The new pig model was successfully tried in our laboratory. The new procedure showed the advantages of easy anastomoses, stable intraoperative hemodynamics, less complications and high survival rate.
出处
《外科理论与实践》
2003年第6期467-470,474,共5页
Journal of Surgery Concepts & Practice
基金
浙江省科技计划项目资助(001110232)
