无静脉转流条件下猪原位肝移植模型的建立  

Establishment of orthotopic liver transplantation model in pigs without veno-venous bypass

作　　者：韩俊峰[1] 高伟[2] 刘蕾[2] 史源[2] 丁梅[1] 沈中阳[2] 

机构地区：[1]天津医科大学一中心临床学院,300192 [2]天津市第一中心医院器官移植中心

出　　处：《中华器官移植杂志》2014年第5期310-312,共3页Chinese Journal of Organ Transplantation

基　　金：国家高技术研究发展计划（863计划）（2012AA021001）;天津市科技计划项目（12ZCZDSY02600）

摘　　要：目的总结建立无静脉转流条件下猪原位肝移植模型的经验。方法以巴马小型猪作为肝移植模型的供、受猪，建立16对无静脉转流条件下猪原位肝移植模型，术中依次吻合供、受猪的肝上下腔静脉、门静脉、肝下下腔静脉及胆总管。观察术中受猪血流动力学的变化特点，记录无肝期时间、手术耗时、术后5d受猪存活率及死亡原因。探讨围手术期相关处理对存活率的影响。结果16对无静脉转流条件下猪原位肝移植中，供肝冷缺血时间为（356．3±66．4）min，无肝期（22．5±2．6）min，手术耗时（185．7±24．8）min。无肝期时受猪的中心静脉压和平均动脉压快速下降，明显低于基础水平即无肝期前水平（P〈（）．05），而心率则明显加快（P〈（）．05）；至门静脉和肝动脉开放后，中心静脉压、平均动脉压及心率均逐渐恢复正常。受猪均于术后142h拔管，并于手术当天麻醉清醒，术后第3天左右开始进食。术中无受猪死亡，术后3d时死亡1只受猪，死亡原因为腹腔感染，术后5d时受猪的存活率为93．8％（15／16）。结论无静脉转流条件下猪原位肝移植模型具有良好的稳定性与可重复性。通过无肝期前和无肝期快速补液及不加用任何血管活性药物维持无肝期平均动脉压不低于50mmHg，在此基础上使无肝期尽量缩短，有利于肝移植手术的成功。Objective To summarize the experience of orthotopic liver transplantation in pigs without veno-venous bypass. Method In general, Bama miniature pigs were used as both the donors and the recipients. Suprahepatic inferior vena cava and portal vein anastomosis was performed with running prolene sutures. After completion of the portal vein anastomosis, the graft was reperfused. Infrahepatic inferior vena cava anastomosis and hepatic artery anastomosis were performed in a similar fashion. Finally, the common bile duct was reconstructed. Result For all of the transplant procedures, the average cold ischemic time was 356. 3± 66. 4 rain and anhepatic time 22. 5 ± 2. 6 rain, and the average operative time was 185.7 ± 24. 8 rain. During the anhepatic phase, the central venous pressure （CVP） and the mean arterial pressure （MAP） were significantly lower than those at baseline （P〈 0. 05）. Heart rate （HR）, on the other hand, was increased significantly during the anhepatic phase （P〈0. 05）. By the time the portal vein and the hepatic artery were reperfused, and CVP and MAP were gradually elevated, and HR gradually reduced. All receptors were successfully extubated and awake after surgeries. On the third postoperative day they began to eat. All receptors survived during the intraoperative period, and the survival rate was 93.8~ （15/16） on the fifth postoperative day. One receptor was died on the third postoperative day due to abdominal infection. Conclusion This model has satisfactory stability and reproducibility. Without using any vasoactive substances, to maintain the MAP beyond 50 mmHg in the anhepatic phase and the short anhepatic time are important to perform successful liver transplantation.

关 键 词：猪 肝移植 模型 动物 静脉分流术 

分 类 号：R657.3[医药卫生—外科学]