体外持续肝脏灌注常温保存和HTK液低温保存无心跳供肝效果的比较  

Preservation of non-heart-beating donor livers by normothermic extracorporeal liver perfusion vs in cold histidine-trytophan-ketoglutarate solution

作　　者：龚瑾[1] 王西墨[2] 龙刚[2] 金中奎[3] 李国逊[4] 江涛[2] 陈实[5] 

机构地区：[1]暨南大学附属第一医院肝胆外科,广州510630 [2]天津市人民医院外科 [3]北京朝阳医院外科 [4]北京世纪坛医院外科 [5]华中科技大学同济医院器官移植研究所

出　　处：《中华器官移植杂志》2008年第8期456-459,共4页Chinese Journal of Organ Transplantation

基　　金：国家十五“863”课题（2001AA216071）

摘　　要：目的比较应用组氨酸-色氨酸-酮戊二酸（HTK）液低温保存和体外持续肝脏灌注（ECLP）系统常温保存无心跳供肝的效果。方法按保存方法不同将供肝随机分为A组和B组：供肝切取后，A组用HTK液在低温下保存10h；B组用ECLP系统在常温下用稀释的自体血液持续灌注10h。两组供肝再经过60min冷缺血期后，连接ECI，P系统用稀释的自体血液再灌注4h。观察再灌注后1、2、3、4h四个时间点的胆汁分泌量，门静脉和肝动脉的压力，肝脏耗氧率的变化，灌注液中丙氨酸转氨酶（ALT）、乳酸脱氢酶（LDH）、葡萄糖水平以及灌注后供肝的常规病理和超微病理变化。结果B组再灌注后1、2、3、4h时间点的胆汁分泌量，门静脉和肝动脉的压力，灌注液中ALT、LDH和葡萄糖水平，以及2、3、4h时间点的耗氧率与A组比较，差异均有统计学意义（P〈0．05或P〈0．01）；B组供肝的病理损害程度较A组轻。结论供肝切取后10h内，利用ECLP系统持续灌注常温保存比用HTK液单纯低温保存在维持无心跳供肝的功能和生理活性方面效果更好。Objective To compare preservation by the standard method of simple cold storage in HTK solution with that by extracorporeal liver perfusion. Methods Livers were harvested from health pigs, which were preserved for 10 h by either cold storage in HTK solution （group A, n = 4） or by perfusion with oxygenated autologous blood at body temperature （group B, n = 4）. Both groups were then tested on the circuit for a 4 h reperfusion phase, and the data of bile production, hemodynamic parameters and the markers of hepatocyte and reperfusion injury of extracorporeal livers in each were analyzed at the end of reperfusion. Results At 1st, 2nd, 3rd and 4th h after reperfusion, the data of bile production, hemodynamic parameters and the markers of hepatocyte and reperfusion injury of livers in group A were statistically different from those of livers in group B （P〈0. 05 or P〈0. 01）. Conclusion Compared with simple cold storage in HTK solution, extracorporeal liver perfusion is a superior method of preservation to non heart-beating donor livers.

关 键 词：肝 灌流 器官保存液 低温保存 

分 类 号：R657.3[医药卫生—外科学] R814.42[医药卫生—临床医学]