小体积肝移植和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观察  

Evaluation of small-for-size liver transplantation and auxiliary partial orthotopic liver transplantation with small-for-size graft for porcine acute hepatic failure

作　　者：彭承宏[1] 肖卫东[2] 吴伟顶[3] 周光文[1] 陈皓[1] 张明均[1] 李宏为[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院外科及器官移植中心,上海市200025 [2]南昌大学第一附属医院普通外科,南昌市330006 [3]浙江省人民医院普通外科,杭州市310014

出　　处：《中华肝胆外科杂志》2006年第10期699-703,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：上海市科技发展基金资助项目(项目号:02DJ14038)

摘　　要：目的观察小体积肝移植和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。方法急性肝功能衰竭猪随机分为3组接受肝移植治疗:A组行全肝移植(n=5);B组行小体积肝移植(n=5);C组行辅助性原位小体积肝移植(n=5)。各组动物开腹后即刻、切脾后即刻和再灌注后30 min分别监测门静脉压力,并观察术后生化指标变化、病理改变和1周生存率。结果A、B和C三组的移植肝重量与受体体重之比分别为(2．44±0．30)％、(0．76±0．02)％和(0．75±0．03)％。再灌注后30 min,B组移植肝门静脉压力显著高于其它两组(A:B:C=13．3:17．5:12．2 cmH2O, P<0．01),C组原肝门静脉压力显著高于移植肝门静脉压力(14．3:12．2 cmH2O,P<0．05)。A组和C组术后第2天起血清天冬氨酸转氨酶、总胆红素、凝血酶原时间、乳酸和血氨水平明显下降,术后第7天基本恢复至正常水平。B组术后上述生化指标一直维持在较高的水平,术后第2～4天明显高于其它两组(P<0．01)。A组、B组和C组1周生存率分别为100％、20％和80％,B组明显低于其它两组(P<0．05)。结论辅助性原位小体积肝移植治疗急性肝功能衰竭近期疗效优于小体积肝移植,术中不必干预原肝门静脉。Objective To evaluate the short-term efficacy of small-for-size liver transplantation （LT） and auxiliary partial orthotopic liver transplantation （OLT） with small-for-size graft for porcine acute hepatic failure. Methods The pigs with acute liver failure were randomized into 3 groups. The animals in group A received total OLT （n=5）, those in group B small-for size LT （n=5） and those in group C auxiliary partial OLT with small-for-size graft （n= 5）. The recipient＇ s portal vein pressure （PVP） was determined at laparotomy, immediately after splenectomy and 30 min after reperfusion, respectively. The clinical manifestations, biochemical and pathological changes and 7-d survival rate were investigated in the 3 groups. Results The graft-to-recipient weight ratio was （2. 44±0. 30）%, （0. 76±0. 02） % and （0. 75±0. 03） % in the 3 groups, respectively. The PVP was significantly higher in group A than in group B and C 30 rain after reperfusion （P〈0. 01）. The PVP of native liver was markedly higher than that of graft liver in group C （P〈0.05）. The levels of AST, T-Bil, PT, lactate and ammonia in group A and C began to decrease on postoperative day （POD） 2 and returned to normal on POD 7. Higher values of AST, T-Bil, PT, lactate and ammonia were found in group B during POD 2-4 （P（0. 05）. The 7-d survival rate was remarkably higher in group A and B than in group C （P〈0. 05）. Conclusions The short-term efficacy of auxiliary partial OLT with small-for-size graft is better than that of small-for-size LT for acute porcine hepatic failure. It is not necessary to intervene with the native liver portal vein upon application of auxiliary partial OLT with small-for-size graft for acute hepatic failure.

关 键 词：肝移植 猪 急性肝功能衰竭 辅助性部分原位肝移植 小体积移植物 

分 类 号：R657.3[医药卫生—外科学]