不同灌注方式对供肝质量的影响  

Impact of perfusion methods on the quality of liver graft

作　　者：古维立[1] 翁杰锋[1] 肖海[1] 巫泓生[1] 梁柳森[1] 陈珊茗[1] 

机构地区：[1]广东省广州市第一人民医院普外科,510180

出　　处：《广东医学》2008年第10期1623-1625,共3页Guangdong Medical Journal

基　　金：广东省医学科学技术研究基金资助项目(编号:A2007486);广州市医药卫生科技项目(编号:2006-YB-015)

摘　　要：目的探讨不同的灌注方式对供肝质量的影响并阐明其作用机制。方法通过体外、体内两种实验方法检验。54只大鼠用于体外实验,采用不同的灌注液(HCA液+UW液)冷灌注供肝,按8,16,32 h时间冷保存肝脏,然后检测相应冷保存时限后,经肝脏灌注的灌洗液中丙氨酸转氨酶(ALT)的变化,并动态观察肝脏保存前后重量差、组织学的改变;48只大鼠用于体内实验,采用kamada的双套管法,设单纯UW液灌注作为对照组,实验组是先用HCA液再用UW液灌注的方法灌注冷保存后(12,24 h)进行原位肝移植,移植12 h后抽血检测反映肝功能变化的ALT、以及肝脏病理改变。结果①体外实验显示冷保存8 h,灌注液中ALT值,3组间差异无显著性(P>0.05),但冷保存16,32 h后的ALT值对照组均明显低于实验组1、实验组2,差异有显著性(P<0.05);16 h冷保存后肝重量差显示,实验组1、实验组2肝重量差均小于对照组,差异有显著性(P<0.05),但3组冷保存32 h后的肝脏均较保存前加重,差异无显著性(P>0.05)。②体内实验提示肝脏冷保存12,24 h后移植,实验组的ALT值高于对照组,组间差异有显著性(P<0.05);肝脏病理支持前述的改变。结论体外、体内的实验均显示:先予HCA液、再用UW液的灌注模式,和单纯UW液灌注方法相比较,前者的方法在抑制肝脏水肿、维持肝细胞机能稳定等方面作用较差,且随冷保存时间的延长,这种供肝灌注模式的负面影响更加明显。Objective To study the effects of two different perfusion methods on the quality of liver allograft in rats. Methods （1）In ex vivo experiments, rats were randomly divided into two groups. Liver allograft in group 1 used perfusion fluid including HCA solution and UW solution, while group 2 only used UW solution for perfusion, After cold perfusion, liver allografts were preserved for 8, 16 and 32 hours. ALT and LDH in the preservation fluid were analyzed. Weight and microstructure of liver were examined, （2）In in vivo experiments, rat liver transplantation model was created by using kamada＇s two sleeves method. Liver allografts were perfused by the two different perfusion fluid mentioned above and subsequently were preserved in UW solution for 12,24 hours, Twelve hours after liver transplantation, blood concentration of ALT and LDH, changing in weight and microstructure of liver were analyzed. Results （1）In ex vivo experiment, liver allograft was preserved for 8 hours and the level of ALT and LDH was not different. After preservation for 16 and 32 hours, the level of ALT and LDH in group 1 was significantly higher than that in group 2, There were no significant differences in the weight of liver allograft after preservation for 32 hours, （2）In vivo experiments showed that blood concentration of ALT and LDH in group 1 were significantly higher than that in group 2. Microstructure of liver allograft was consistent with the chemistry, Conclusion Compared with UW solution as perfusion and preservation fluid, HCA solution followed by UW solution is less effective in protecting liver allograft. With the increase of preservation time of liver allograft, the side effects of HCA solution are more prominent.

关 键 词：高渗枸橼酸盐腺嘌呤液 UW液 肝脏移植 供肝灌注 

分 类 号：R657.3[医药卫生—外科学] R654.1[医药卫生—临床医学]