体外膜肺氧合支持对猪控制型心死亡模型供体小肠移植术后早期肠功能的影响  

Influence of extracorporeal membranous oxygenation on early allograft function after intestinal transplantation

作　　者：郭明晓[1] 高鹰[1] 路春雷[1] 李幼生[2] Guo Mingxiao;Gao Ying;Lu Chunlei;Li Yousheng(Department of General Surgery Center,Linyi People's Hospital,Linyi 276000,China;Department of General Surgery,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China)

机构地区：[1]临沂市人民医院普外科,临沂276000 [2]上海交通大学附属第九人民医院普外科,上海200011

出　　处：《中华解剖与临床杂志》2022年第4期273-280,共8页Chinese Journal of Anatomy and Clinics

基　　金：国家自然科学基金(81500688);山东省自然科学基金(ZR2015HL033,ZR2021MH362);山东省医药卫生科技发展计划项目(2016WS0237)。

摘　　要：目的探讨体外膜肺氧合(ECMO)技术对控制型心死亡模型猪供体小肠移植后早期肠道功能的影响。方法选取体质量22~25 kg白色杂种猪48只,按数字表法随机分为正常对照组(LD组)、心死亡供体组(DCD组)、ECMO支持1 h组(E1组)和ECMO支持3 h组(E3组)共4组,每组12只;每组再随机分为供体组和受体组2个亚组,每个亚组各6只。LD组的供体亚组常规截取移植用小肠;DCD组的供体亚组先建立DCD模型,然后截取移植用小肠;E1、E3组的供体亚组,先建立DCD模型,再分别采用ECMO支持1、3 h后,截取移植用小肠。各受体亚组行小肠移植手术。分别于肠移植前、移植后再灌注1 h及移植后第1、3、5、7天经移植肠造口活检钳切取各受体亚组移植肠组织制备病理切片,采用Park/Chiu评分系统评估肠组织损伤程度,透射电镜下观察移植术后第7天小肠黏膜超微结构,免疫组织化学染色观察移植术后再灌注1 h时肠黏膜细胞凋亡因子caspase-3表达水平。分别于移植前和移植术后第1、3、5、7天采集各受体亚组猪颈外静脉血,检测血清D-乳酸水平评估肠黏膜受损情况及肠道通透性;移植术后第7天检测血浆D-木糖最大浓度评估移植肠吸收能力。结果(1)各受体亚组组织病理学评分:小肠移植术前,各组移植肠均有肠黏膜损伤,其中E3组肠黏膜损伤最重,肠黏膜损伤程度Park/Chiu评分E3组高于LD组、DCD组及E1组,差异均有统计学意义(P值均<0.05),而LD组、DCD组、E1组间Park/Chiu评分比较,差异均无统计学意义(P值均>0.05)。小肠移植术后再灌注1 h和术后第1天时,DCD组Park/Chiu评分最高,明显高于LD组、E1组、E3组,差异均有统计学差异(P值均<0.05);而LD组、DCD组、E1组Park/Chiu评分比较,差异均无统计学意义(P值均>0.05)。术后第3、5、7天,LD组、DCD组、E1组、E3组Park/Chiu评分差异均无统计学意义(P值均>0.05)。(2)各受体亚组肠黏膜超微结构:术后第7天各组移Objective To evaluate the effect of extracorporeal membranous oxygenation(ECMO)on early allograft function after intestinal transplantation.Methods Forty-eight domestic crossbred pigs were assigned to living donation(LD),donation after cardiac death(DCD),E1,and E3 groups.Each group was randomly divided into two subgroups,with six pigs each.The small intestine donor of the LD subgroup was obtained for transplantation routinely.The DCD model of the DCD subgroup was first established,and then the small intestine donor was obtained for transplantation.The donor subgroups of the E1 and E3 groups were used to first establish the DCD model.Then,1 and 3 h ECMO was used to obtain a small bowel for transplantation,respectively.Small bowel transplantation was performed in each subgroup of recipients.The transplanted intestinal tissues of each recipient subgroup were obtained to evaluate pathological sections before bowel transplantation;1 h after reperfusion after transplantation;and 1,3,5,and 7 days after transplantation.The Park/Chiu scoring system was used to evaluate the degree of intestinal tissue damage.The ultrastructure of small intestinal mucosa was observed under a transmission electron microscope on day 7 after transplantation,and the expression of caspase-3 in the intestinal mucosa was observed by immunohistochemical staining 1 h after transplantation after reperfusion.The external jugular vein blood of each recipient subgroup was collected before transplantation and 1,3,5,and 7 days after transplantation,and the serum D-lactic acid level was measured to assess the damage of the intestinal mucosa and intestinal permeability.The maximum plasma D-xylose concentration was measured on the 7th day after surgery to evaluate the absorption capacity of the transplanted intestine.Results(1)Histopathologic evaluation of subgroup of recipients:Before transplantation,the Park/Chiu score in the E3 group was significantly higher than that in the LD,DCD,and E1 groups(all P values<0.05).The Park/Chiu score in all three groups s

关 键 词：器官移植 小肠 控制型心死亡供体 体外膜肺氧合 猪 模型 动物 

分 类 号：R656.7[医药卫生—外科学] R-332[医药卫生—临床医学]