辅助性原位小体积肝移植治疗猪急性肝功能衰竭的近期疗效  

Short-Term Efficacy of Auxiliary Partial Orthotopic Liver Transplantation with Small-for-Size Graft for Porcine Acute Hepatic Failure

作　　者：吴伟顶[1] 彭承宏[1] 肖卫东[1] 周光文[1] 张明钧[1] 陈皓[1] 张弘炜[1] 李宏为[1] 

机构地区：[1]上海交通大学医学院瑞金医院器官移植中心,上海200025

出　　处：《上海交通大学学报（医学版）》2006年第6期586-590,共5页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海市科委科技发展基金(02DJ14038)资助项目

摘　　要：目的探讨辅助性部分原位肝移植治疗猪急性肝功能衰竭的近期疗效及其对小体积移植物的保护作用。方法15只健康雌性家猪经门静脉注射D-Gal(每千克体质量0.5 g)和LPS(每千克体质量1μg)诱导急性肝功能衰竭,24 h后接受肝移植治疗。动物随机分为60%原位辅助性部分肝移植组(A组,n=5)、30%小体积肝移植组(B组,n=5)和30%小体积原位辅助性部分肝移植组(C组,n=5)。各组动物于开腹后即刻、切脾后即刻和再灌注后30 m in分别监测门静脉压力,观察术后生化指标变化、病理改变和1周生存率。结果A、B、C组的1周生存率分别为100%、20%、80%,A、C组生存率明显高于B组(P<0.05)。术后第2天开始,A、C组血清天冬氨酸转氨酶、总胆红素、血氨、乳酸明显低于B组(P<0.05)。再灌注后30 m in,B组平均门静脉压明显高于A、C组。再灌注后30 m in、3 h,病理观察结果显示,B组出现严重肝窦淤血、片状肝实质细胞空泡变性。结论急性肝功能衰竭时,加用辅助性原位部分肝移植,可以明显提高小体积移植物的近期存活率。该作用可能与门静脉血流的分流和压力下降有关。Objective To evaluate the short-term efficacy of small-for-size liver transplantation and auxiliary partial orthotopic liver transplantation （APOLT） with small-for-size graft for porcine acute hepatic failure. Methods Fifteen healthy female domesticated pigs received liver transplantaion 24 h after being induced acute hepatic failure by intraportally administration of 0.5 g/kg D-Gal plus 1 μg/kg LPS. Recipients were randomly divided into three groups： group A, 60% APOLT, n =5; groupB, 30% small-for-size liver transplantaiton, n =5; group C, 30% small-for-size APOLT, n = 5. The portal vein pressure of the recipients was measured at laparatomy, immediately af- ter splenectomy and 30 min after reperfusion. The clinical manifestations, biochemical and pathological changes and one-week survival rate were observed. Results One-week survival rate was 100% , 20% and 80% , respectively.Group A and C demonstrated significantly better survival than group B （P 〈0.05）. Serum aspartate transaminase,lactate, total bilirubin and ammonia in group A and C were much lower than those of group B on the second day after operation. The portal pressure after reperfusion in group B was significantly higher within 30 min than those in group A and C. After reperfusion, group B showed severe sinusoidal congestion, collapse of the space of Disse, vacuolar changes in cytoplasm of hepatocytes and rounded, detached sinusoidal cells. Conclusion In acute hepatic failure,APOLT can significantly increase the short-term survival of small-for-size graft. This function may be related to the reduction of portal pressure of the graft.

关 键 词：急性肝功能衰竭 辅助性部分原位肝移植 小体积移植物 猪 

分 类 号：R657.3[医药卫生—外科学]