二步法大鼠原位全小肠移植模型的建立与改进

Establishment of two-step orthotopic small intestinal transplantation in rats

目的:建立一种简单稳定、死亡率低的二步法大鼠原位小肠移植模型.方法:整块获取带肠系膜上动脉的腹主动脉和门静脉的全小肠,血管重建采用供体腹主动脉和受体腹主动脉端侧吻合、供体门静脉和受体左肾静脉端套管吻合.受体第一步手术时,供肠远端端侧吻合于受体的末端回肠,已结扎的供肠近端固定于右侧腹壁(不做腹壁造口).7d后行第2步手术,自Tritze韧带下1cm到回肠吻合口上1cm切除受体小肠,受体空肠残端端侧吻合于供肠近端.结果:共进行二步法大鼠原位小肠移植手术174次,正式实验44次,手术成功率90.9%.受体第1次手术时间约50±15 min,其中动脉吻合时间约为20±5 min,静脉吻合时间2±1 min,受体第2次手术时间约35±15 min.4只大鼠死于第一次手术后5 d内,2只死于肠瘘,1只死于麻醉意外,1只死于肠梗阻.第2次术后没有大鼠死亡,40只大鼠均长期存活(超过3 mo).结论:二步法大鼠原位小肠移植方法安全可靠,并发症少,生存率高.

AIM： To establish a simple and stable model of orthotopic small intestinal transplantation in rats that minimizes mortality.METHODS： The graft removed en bloc consisted of the entire small intestine, portal vein and donor aortic segment, along with the superior mesenteric artery. The graft was perfused in situ and the gut lumen was irrigated during the operation. Revascularization was accomplished by end-to-side anastomosis of the graft aortic segment to the prepared recipient aorta, and by the formation of a cuff anastomosis between the donor portal vein and the recipient left renal vein. In the first part of the two-stage procedure, the distal end of the graft was anastomosed tothe side of the distal ileum, and the proximal end was fixed to the abdominal wall. Seven days after heterotopic transplantation, the second procedure was performed. The native small in- testine above the jejunojejunostomy was resected and the distal end was closed. The proximal end was end-to-side anastomosed to the proximal end of the graft.RESULTS： A total of 174 intestinal transplanta- tions were performed in rats, 44 of which were in the formal experimental group, with a surviv- al rate of 90.9%. The time for recipient surgery was 50 ＋ 15 min. The average time for the arte- rial and venous anastomoses was 20 ± 5 min and 2 ± 1 min, respectively. The average time for the two-stage surgical procedure was approximately 35 ± 15 min. Four rats died within 5 d of the first operation. These technical failures were due to anesthesia complications, intestinal fistula and intestinal obstruction. No rats died after the sec- ond operation. Forty animals survived for 〉 3 mo.CONCLUSION： The two-stage orthotopic in- testinal transplantation technique used in this study allows graft recovery from ischemic dam- age, the avoidance of life-threatening intestinal anastomotic complications, and increases sur- vival rate.