中叶供肝肝移植的可行性动物实验研究  

Experimental feasibility study of liver transplantation using medial split liver graft

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

机构地区：[1]南京医科大学附属南京儿童医院普通外科,江苏南京210008 [2]解放军总医院小儿外科,北京100853 [3]首都儿科研究所外科,北京100020 [4]北京军区总医院附属八一儿童医院泌尿外科,北京100700

出　　处：《中国普通外科杂志》2012年第1期23-29,共7页China Journal of General Surgery

基　　金：国家"十一五"科技支撑计划(2006BAI05A06);首都临床特色应用研究(D101100050010064)

摘　　要：目的:探索肝中叶作为独立供肝进行移植的可行性,以进一步拓宽供肝来源。方法:普通级健康犬分成供体组(n=12,20～25 kg)和受体组(n=12,10～15 kg),供受体随机配对。供体手术将位于中央区的方叶、右中叶在体内劈离,原位灌注后保留其专属的门静脉中支、肝中动脉和中肝管,得到独立的中央区供肝并称重。受体手术先建立临时性门腔分流,供肝背驮式植入,流出口和腔静脉壁端侧吻合,供肝门静脉中支和受体门静脉主干行端端吻合后恢复新肝血流,重建动脉和胆管。术后观察受体腹腔及胆汁引流,每日检测肝功能,死亡后行尸检,移植物取标本行病理检查。结果:犬肝被深陷的叶间裂分隔成7叶,各叶间由较少的肝桥连接,方叶和右中叶由门静脉中支、中肝动脉营养血回流至肝中静脉,胆汁引流至中肝管。供体组体内劈离技术全部得以完成,手术时间(215.0±67.7)min,失血量(229.3±66.5)mL。比较GRWR,中央区供肝[(1.3±0.3)%]和假设的左侧区供肝的[(2.1±0.4)%]及右侧区供肝的[(0.9±0.1)%]之间差异均有统计学意义(均P<0.01)。受体组手术时间(327.6±75.3)min,无肝期(33.6±7.5)min,失血量(415.5±79.8)mL。12个供肝均成功植入,冷缺血时间为(41.9±12.1)min,(8.3±3.6)min后排泌胆汁。受体肝功能指标在术后第1天发生明显变化,随后逐渐恢复,中位存活时间92.5(18～272)h,未发现有因吻合口出血、血栓等外科技术性并发症而死亡受体。结论:犬动物模型证实肝中央区可以劈离出来作为一个独立的供肝器官,为将来拓宽供肝来源提供了另外一种思路。Objective： To investigate the feasibility of liver transplantation using the independent medial split liver graft, so as to broaden the sources of donor liver. Methods： Healthy adult mongrel dogs were divided into donor group （n=12, 20-25 kg） and recipient group （n=12, 10-15 kg）, and each of the donors was then randomly paired with a recipient. In the donor operation, the middle part of the liver （quadrate lobe and right medial lobe） was splitted in vivo, and then along with the medial portal branch, middle hepatic artery and hepatic duct, the independent medial split liver graft was procured and weighed after in situ perfusion. In the recipient operation, a temporary portacaval shunt was created before hepatectomy; implantation was done by piggyback technique, whereby the outflow orifice of the graft was anastomosed to the anterior wall of the recipient vena cava in an end-to-side manner, and the blood flow of the transplanted liver was restored by an end-to-end anastomosis of the donor medial portal branch and the main trunk of the recipient portal vein, and finally the reconstruction of the hepatic artery and biliary duct was performed. The biliary tract and abdominal drainage were detected daily after operation. After recipient＇s death, autopsy was done and pathological examination of the graft specimen was performed. Results： The canine liver was divided by deep fissures into seven lobes, which are connected by meager parenchymal bridges. The quadrate lobe and right medial lobe are supplied by the medial portal branches and middle hepatic artery, and their blood is returned via the middle hepatic vein; biliary drainage is by the middle hepatic duct. In the donor group, the in situ splitting procedures were all accomplished, and the average operative duration was （215.0±67.7） min and bleeding volume was （229.3±66.5） mL. The graft-recipient weight ratio （GRWR） of middle part liver graft [（1.3±0.3） %] was significantly different （P〈0.01） from that of the presumed lef

关 键 词：肝移植/方法 劈离式肝移植 肝中叶 模型 动物 

分 类 号：R617[医药卫生—外科学]