临时性门腔静脉架桥联合流出道改良重建在部分供肝肝移植中应用的实验研究  

Experimental study on a combined method of temporary portocaval bridging and modified outflow reconstructed technique for partial Hver transplantation

作　　者：周峻[1,2] 王政[3] 李龙[2] 侯文英[2] 谢华伟[4] 崔龙[2] 王文晓[2] 张金山[2] 刘树立[2] 李胜利[2] 明安晓[2] 

机构地区：[1]北京协和医学院研究生院,北京市100730 [2]首都儿科研究所,北京市100020 [3]中国人民解放军总医院小儿外科,北京市100853 [4]北京军区总医院附属八一儿童医院,北京市100700

出　　处：《临床小儿外科杂志》2011年第3期179-183,共5页Journal of Clinical Pediatric Surgery

基　　金：本研究为国家“十一五”科技支撑计划课题（项目号：2006BA105A06）以及2010年北京市科技计划项目

摘　　要：目的通过动物肝移植实验，探索门腔静脉架桥和改良肝静脉出口重建这一联合方法的可行性及价值。方法选择20～25妇和10～15kg健康杂交犬各12只，组成供体组和受体组，并随机配对。供体手术取左外侧叶及左中央叶为供肝，然后完全阻断门静脉。受体犬先预置门腔静脉之间端侧吻合架桥的分流通道，切肝门静脉阻断时开放，供肝植入门静脉吻合后关闭，供肝在部分阻断后腔静脉的条件下背驮式植入，流出道吻合在受体后腔静脉侧壁上。观察门静脉阻断前后供受体生命体征和内脏器官情况，以及门脉血流的血气、生化、压力变化，超声测量并计算受体在阻断前门静脉血流量，并和阻断15min后的分流量进行比较。结果供体组门静脉阻断后迅速出现血压下降，心率增快，5min后门脉压迅速升高至（54．5±12．0）cmH2O，P〈0．01，30min后仍处于较高水平（32．2±4．9）cmH2O，P〈0．01，而门脉血pH降至7．03±0．18（P=0．002），BE降至（-21．3±5．5）mmol／L，P=0．001，乳酸脱氢酶升高至（388．4±150．9）U／L，P=0．002，内脏器官出现严重淤血、水肿、渗出。在无体外转流措施的条件下，受体组经过预先分流处理后均能安全接受供肝植人，无术中死亡者，阻断门静脉主干5min时门脉压稍升高至（18．8±3．1）cmH2O，P=0．046，10min时降至正常（17．8±3．9）cmH2O，P=1．000，30min时仍稳定在（16．3±2．3）cmH2O，P=1．000，内脏颜色红润。受体组分流血流量（276．4±34．1）mL／min和分流前门静脉血流量（291．8±24．7）mL/min比较，差异无统计学意义（P=0．219）。结论在部分供肝背驮式肝移植手术时，预置临时性门腔静脉架桥分流，配合改良肝静脉重建术能同时保持受体下腔静脉和门静脉血流的连续性，有效解除无肝期门脉系统血流瘀滞的问题。Objective Classic liver transplantation, the most effective therapeutic option for children with end-stage liver disease, involves the interruption of portal venous flow. To further steady the hemodynamic and metabolic status of recipient, in this experimental study, the canine model was built to explore the feasibility and applicable value of a new method which was combined with temporary portocaval bridging and modified outflow reconstructed technique. Methods Healthy mongrel dogs were enrolled in donor group （25 -30 kg, n = 12） and recipient group （10 - 15 kg, n = 12）. Random pair was matched between donor and recipient animal. For donor operation, portal vein was clamped when left lateral lobe and left medial lobe were procured as a whole graft. For recipient operation, a temporary portacaval shunt was created with the jugular interposition graft in an end-to-side fashion, initiated when portal vein was clamped until the graft was revaseularized. After a cross-clamp applied below the common trunk of the left and middle hepatic vein, an end-to-side anastomosis was performed between outflow orifice of the graft and anterolateral wall of recipient vena cava. During operation, the changes of life signs, splanchnic organs, and blood gas index, serum biochemical parameter, pressure of portal vein were observed and recorded for every animal in both groups. By means of Doppler ultrasound measuring, the shunt flow volume at 15min after portal blocking was compared with normal portal venous flow volume for every recipient. Results Heart rate increase and blood pressure drop were noted soon after clamping of donor portal vein. 5min afterwards, the portal venous pressure reached its peak level of （54.5 ±12.0） cmH2O rapidly （ P 〈 0.01 ）. At 30 min after clamping, portal pressure still remained a relatively high level at （32.2 ±4.9 ） cmH2O （P 〈 0.01 ）, and meanwhile severely congestion, edema and exudation generally occurred in splanchnic organs. In recipient group, the prearrangement of tempo

关 键 词：肝移植/方法 动物实验 

分 类 号：R657.3[医药卫生—外科学]