大鼠减体积肝移植腹腔出血的原因分析  

A causal analysis of intra-abdominal hemorrhage after reduced-size liver transplantation in rats

作　　者：刘静[1] 李江[2] 张升宁[1] 李铸[1] 李来帮[1] 冉江华[1] 李立[1] 

机构地区：[1]昆明医学院附属甘美医院肝胆胰一科,云南昆明650011 [2]昆明医学院附属第一医院肝胆外科,云南昆明650032

出　　处：《南方医科大学学报》2010年第5期1075-1078,共4页Journal of Southern Medical University

基　　金：云南省重大科技项目(2007CA007)

摘　　要：目的探讨大鼠减体积肝移植腹腔出血的原因。方法实验大鼠均为健康的SD大鼠,体质量260～280g,供体为雌性,受体为雄性,供、受体体质量相差10g左右,一般为供体体质量比受体体质量轻;供体采用单人裸眼操作,在取肝的过程中即进行减体积操作;受体采用双人裸眼配合操作建立大鼠减体积的稳定模型。结果成功实施的270对大鼠减体积肝移植模型中,因腹腔出血而死亡44例,死亡率为16.3﹪;出血部位的总体分布为肝上下腔静脉吻合口出血28例次,肝脏包膜渗血9例次,肝左外侧叶减体积结扎点出血9例次,肝乳头叶结扎点出血7例次,肝三角叶结扎点出血7例次,右肾上腺和腰静脉出血5例次,肝脏人为损伤出血4例次,门静脉套管口出血4例次,肝下下腔静脉套管口出血4例次,其中肝上下腔静脉吻合口合并肝左外侧叶减体积结扎点出血的有8例,两个减体积结扎点均出血的5例;10例经过缝扎或单纯结扎后止血,肝脏包膜渗血采用热盐水冲洗、浸泡后自行止血6例。结论减体积肝移植术后腹腔出血最常见的是肝上下腔静脉吻合口出血,通过对大鼠减体积肝移植术后腹腔出血的原因分析,其结果可以指导我们实验手术操作的进一步改进,从而提高大鼠肝移植模型的实验手术成功率。Objective To analyze the cause of abdominal hemorrhage after reduce-size liver transplantation in rats. Methods Healthy female SD rats were used as the donors and male SD rats as the recipients （weighing 260-280 g）, with the recipients weighing 10 g more than that of the donors. The donor operation was performed by the same surgeon under direct vision, and the liver graft size reduction procedure was completed in the donor operation. The recipient operation was performed by two surgeons under direct vision. Results A total of 270 SD rats received reduce-size liver transplantation successfully, and 44 of the rats died from intra-abdominal hemorrhage. The abdominal hemorrhages, listed in the order of incidences, included anastomotic hemorrhage of the inferior vena cava of the superior liver （28 cases）, subcapsular hemorrhage of the liver （9 cases）, ligation hemorrhage of the left outboard lobe, the nipple lobe and the triangle lobe of the liver （9 , 7 and 7 cases, respectively）, hemorrhage of the right suprarenal vein and lumbar veins （5 cases）, hemorrhage of the mechanical injury （4 cases）, cuff hemorrhage of the portal vein and inferior vein cava of the inferior liver （both 4 cases）. Eight rats had anastomotic hemorrhage of the inferior vena cava of the superior liver and ligation hemorrhage of the left outboard lobe, 5 had hemorrhage of the two ligation points of the reduce-size liver; for management of the hemorrhage, 10 rats received suture or/and ligature, and 6 had washing and hot water bath. Conclusion The most common cause of hemorrhage after reduce-size liver transplantation in rats is the anastomotic hemorrhage of the inferior vena cava of the superior liver, and this finding may provide clues for improving the success rate of reduced size liver transplantation in rats.

关 键 词：减体积肝移植 大鼠 腹腔出血 

分 类 号：R657.3[医药卫生—外科学]