非转流条件下猪原位肝移植模型的建立及评价  

The establishment and evaluation of orthotopic liver transplantation in swine model without veno-venous bypass

作　　者：杨洋[1] 淮明生[2] 韩俊峰[1] 高伟[2] 

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

出　　处：《实用器官移植电子杂志》2016年第2期75-78,共4页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：天津市科技计划项目(12ZCZDSY02600;14RCGFSY00147;14ZCZDSY00019);天津市卫生局科技基金(2012KZ114)

摘　　要：目的总结非转流条件下猪原位肝移植模型建立的技术难点及经验,为肝移植研究提供重复性和稳定性好、标准化程度高的动物模型。方法以巴马小型猪为实验动物,于2015年2月至2015年6月在非体外静脉转流条件下建立猪原位肝移植术模型。监测术中动物的血液动力学、动脉血气分析及生化指标的变化,监测动物无肝期时间、手术时间、失血量、输血量及术后1天、3天及7天的存活率。结果共建立27例非转流条件下猪原位肝移植模型。供肝冷缺血时间为(125.3±20.4)分钟,无肝期为(20.6±2.3)分钟,平均手术时间为(178.7±26.3)分钟。与无肝期前相比,无肝期血流动力学和代谢发生急剧变化,中心静脉压(CVP)、平均动脉压(MAP)、p H值及剩余碱显著下降〔CVP(cm H_2O):1.52±0.33比5.83±0.58,MAP(mm Hg):52.34±5.73比94.53±7.87,p H值:7.31±0.03比7.40±0.02,剩余碱(mmol/L):-8.34±3.7比0.64±2.02,均P<0.05〕,心率、血清K^+水平则明显上升〔心率(次/分):148.00±7.74比92.00±9.64,血清K^+(mmol/L):4.82±0.52比4.13±0.37,均P<0.05〕。门脉及腔静脉开放后,血流动力学及代谢紊乱逐渐恢复正常。实验动物无术中死亡现象,术后3天及7天的存活率分别为96.3%和88.9%。结论维持无肝期血流动力学的相对稳定、尽量缩短无肝期时间以及减少手术并发症是非转流条件下成功建立猪原位肝移植的关键。Objective To summarize the technical difficulties and experience in the orthotopic liver transplant swine model without veno-venous bypass, to establish the highly reproducible and stabile swine model for liver transplant research. Methods Liver transplant swine model without veno-venous bypass were established by the using of BAMA miniature pigs from Feb 2015 to Jun 2015. Hemodynamics, arterial blood gas analysis and changes in biochemical indicators were monitored during the operation. The time of anhepatic phase, operation time, the amount of blood loss, the amount of blood transfusion and postoperative survival rate were monitored. Results A total number of 27 liver transplantation models were established in swines without veno-venous bypass. Mean cold ischemic time of the donor liver was（125.3±20.4） mins, the mean time of anhepatic phase and operation were（20.6±2.3） mins and（178.7±26.3） mins, respectively. Compared with pre-anhepatic phase,hemodynamics and metabolism changed rapidly during anhepatic phase, central venous pressure（CVP）, mean arterial pressure（MAP）, pH value and base excess decreased significantly 〔CVP（cm H_2O）：1.52±0.33 vs. 5.83±0.58,MAP（mm Hg）：52.34±5.73 vs. 94.53±7.87,pH ：7.31±0.03 vs. 7.40±0.02, base excess（mmol/L）：-8.34±3.70 vs. 0.64±2.02,all P〈0.05〕. Heart rate and serum potassium increased markedly. 〔heart rate（times/min）：148.00±7.74 vs. 92.00±9.64,serum potassium（mmol/L）：4.82±0.52 vs. 4.13±0.37,all P〈0.05〕. Hemodynamics and metabolism gradually return to normal after portal vein and inferior vena cava were opened and blood flow restored. The 3-days and 7-days post-operation survival rates were 96.3% and 88.9% respectively. Conclusion Maintaining hemodynamics stable, decreasing the time of anhepatic phase and reducing the operative complication were the key points of establishing liver transplantation swine model without veno-venous bypass.

关 键 词：原位肝移植 猪 动物模型 

分 类 号：R657.3[医药卫生—外科学]