大鼠脂肪变性供肝移植的可行性研究  

Experimental study of the steatotic donor liver transplantation in rats

作　　者：叶晟[1] 韩本立[1] 董家鸿[1] 

机构地区：[1]第三军医大学附属西南医院全军肝胆外科研究所,西南肝胆外科医院,重庆400038

出　　处：《第三军医大学学报》2003年第10期880-883,共4页Journal of Third Military Medical University

摘　　要：目的　探讨大鼠脂变供肝用于肝移植的可行性及术前病理评估。方法　采用酒精加高脂、高胆固醇的喂饲方法诱导成大鼠不同级别和类型的脂变肝脏 ,通过双袖套、胆管端端缝合法的肝移植模型来评估适宜用于供肝的脂变肝脏。结果　Ⅲ级大泡脂变供肝术后存活率低 ,早期死于肝功能不全 ,肝细胞坏死多 ;Ⅰ级大泡脂变供肝术后生存率和正常供肝无异 ,脂变可较快地逆转 ;Ⅱ级大泡脂变供肝术后存活比正常供肝低 ( 2周存活率 66.7%) ,但检验尚无显著性差别 ,术后脂变不同程度减轻并有肝细胞再生 ( 2 8d) ,坏死较少 ;小泡为主的脂变供肝术后存活率反而较高。结论　Ⅲ级大泡脂变肝脏不宜用作供肝 ;Ⅰ级大泡或Ⅲ级小泡脂变肝脏可较安全地用于肝移植 ,术后脂变肝脏可较快地逆转 ;Ⅱ级大泡脂变肝脏用于肝移植时要考虑肝细胞坏死及缺血性损害因素 ;脂变肝脏炎症活动度计分大于 2 .7者术后存活低 。Objective To explore the effect of fatty liver on graft survival, especially with reference to macrovesicular and microvesicular steatosis and to evaluate the relationship between histological grading and inflammation activity. Methods Different degrees of rat fatty liver model were established by feeding rats a diet consisting of 79% standard diet, 20% lard and 1% cholesterol. By modified two cuff vascular anastomoses and end to end suture for bile duct, rat orthotopic liver transplantation was performed to evaluate the relationship between donor histological grading and survival rate. Results Low survival rate of macrosteatosis (grade Ⅲ) was found. Most rats died of liver failure in early days after transplantation. Pathological findings showed frequent hepatic necrosis. There was no significant difference between macrosteatosia(gradeⅠ) and the normal group. After transplantation, almost all of the fat was cleared by the end of the fourth week. Diminished steatosis and liver regeneration were found in macrosteatosis (gradeⅡ), while microsteatotic donors had higher survival rate than the other groups except the normal group. Conclusion Macrovesicular steatosis(grade Ⅲ) affects graft survival and these steatotic livers should not be used as donors. However, steatotic livers with mild macrovesicular steatosis (grade Ⅰ) and microvesicular steatosis(grade Ⅲ) do not influence recipient survival, so these livers can be used safely for liver transplantation. The ischemic damage should be considered when using livers of macrovesicular steatosis(gradeⅡ). Donors with numbering score more than 2.7 are correlated with the poor survival.

关 键 词：大鼠 脂变供肝 肝移植 

分 类 号：R575.5[医药卫生—消化系统] R617[医药卫生—内科学]