猪暂时性门腔分流背驮式肝移植模型的建立  

Development of an improved pig model of piggyback liver transplantation with temporary portacaval shunting

作　　者：刘静[1] 陈达丰[1] 杨爱国[1] 周松[1] 邹耀祥[1] 聂凯[1] 李冉冉[1] 刘广欣[1] 

机构地区：[1]厦门大学附属东南医院(中国人民解放军第一七五医院)普外科,福建省漳州市363000

出　　处：《世界华人消化杂志》2011年第8期832-835,共4页World Chinese Journal of Digestology

基　　金：福建省青年人才基金资助项目;No.2006F3147;漳州市科技基金资助项目;No.2006(Z06076)~~

摘　　要：目的:探讨猪背驮式肝移植手术的改进方式,提高猪肝移植的生存率.方法:对照组用方法1行猪背驮式肝移植:用彭式解剖分离器"刮吸法"保留下腔静脉,切除受体肝.实验组用方法2,暂时性门腔分流猪背驮式肝移植.在方法1的"刮吸法"保留下腔静脉,切除受体肝的基础上加暂时性门腔分流.冷缺血时间、无肝期、手术时间、失血量、生存期等观察指标用SPSS13.0的t检验和生存分析作统计处理.结果:对照组和实验组分别实施猪肝移植8对.手术成功率分别87.5%、100%.冷缺血时间分别为:142.8min±7.4min,155.6min±8.3min(P=0.006).无肝期分别为:25.8min±1.3min,36.3min±1.0min(P=0.000).手术时间分别为:264.1min±9.5min,277.3min±8.6min(P=0.012).失血量分别为:892.5mL±113.9mL,888.8mL±93.7mL(P=0.94),1d生存率分别为87.5%、100%,2d生存率分别为25%、100%,3d生存率分别为12.5%、87.5%,4d生存率分别为0.0%、87.5%.实验组87.5%肝移植猪术后生存超过10d(P=0.000).结论:猪暂时性门腔分流背驮式肝移植的方法,维持手术期间血流动力学稳定,减轻门静脉系统淤血.减少胃肠道淤血是猪肝移植成功和提高生存率的关键.AIM： To improve the piggy-back orthotopic liver transplantation （PBOLT） technique in pigs and to enhance the survival rate of pigs after liver transplantation.METHODS： Pigs were divided into control group and experimental group.The inferior caval vein was separated from the liver of recipients by curettage and aspiration using Peng’s multifunctional operative dissector in the control group.Temporary portacaval shunting was added in the experimental group to reduce congestion inthe portal system during anhepatic phase.RESULTS： The PBOLT procedures were performed in eight pairs of pigs in both the control group and experimental group,with a success rate of 87.5% and 100%,respectively.There were significant differences in cold ischemia time （142.8 min ± 7.4 min vs 155.6 min ± 8.3 min,P = 0.006）,anhepatic phase duration （25.8 min ± 1.3 min vs 36.3 min ± 1.0 min,P = 0.000）,and operation time （264.1 min ± 9.5 min vs 277.3 min ± 8.6 min,P = 0.012） between the two groups though no significant difference was noted in mean bleeding volume （892.5 mL ± 113.9 mL vs 888.8 mL ± 93.7 mL,P = 0.94）.The 1-,2-,3-and 4-day survival rates were 87.5% and 100%,25% and 100%,12.5% and 87.5%,and 0% and 87.5% in the control group and experimental group,respectively.On day 10 after PBOLT,87.5% of pigs of the experimental group were still alive （P = 0.000）.CONCLUSION： PBOLT with temporary portacaval shunting can maintain hemodynamic sta- bility and relieve congestion of the portal system in pigs during liver transplantation.Control of gastrointestinal congestion is key to the success of liver transplantation and can raise the survival rate of pigs after liver transplantation.

关 键 词：暂时门腔分流 背驮式 猪 肝移植 模型 

分 类 号：R657.3[医药卫生—外科学]