经典原位肝移植术中逆灌注法对移植肝缺血再灌注损伤的影响

Study on the influences of injurys by ischemia and reperfusion to retrograde perfusion in standard orthotopic liver transplantations

目的探讨经典原位肝移植术中逆灌注法对移植肝缺血再灌注损伤的影响。方法35例经典原位肝移植患者随机分为试验组和对照组。试验组17例,采用经下腔静脉逆灌注法,在吻合门静脉前先开放下腔静脉,然后再吻合门静脉、肝静脉;对照组18例,采用常规经门静脉正向灌注法,先开放门静脉,再开放下腔静脉,然后吻合肝动脉。分别测定两组的以下指标:复温缺血时间(RWIT);移植术后1h及术后1、2、3、5、7天血清丙氨酸转氨酶(ALT)、谷氨酰转肽酶(GGT)、总胆红素(TB)、凝血酶原时间(PT);无肝期结束后2h下腔静脉血中的肿瘤坏死因子-α(TNF-α)和白细胞介素-1(IL-1)的浓度;无肝期结束后3h取肝组织活检行光镜检查,高倍镜下计算肝细胞水变性及坏死细胞百分比。结果试验组的RWIT显著短于对照组(P<0.05);术后1小时,术后1、2天试验组TB显著低于对照组(P<0.05),术后3、5、7天两组无差异(P>0.05);术后1、2天试验组ALT显著低于对照组(P<0.05),术后1h、术后3、5、7天两组无差异(P>0.05);术后1h,术后1、3天试验组GGT显著低于对照组(P<0.05),术后2、5、7天两组无差异(P>0.05);两组PT术后无差异(P>0.05);无肝期结束后2h,试验组下腔静脉血中TNF-α,IL-l的浓度显著低于对照组(P<0.05);病理组织学检查显示试验组肝细胞缺血再灌注损伤较对照组轻;无肝期结束后3h,试验组肝细胞水变性及坏死细胞百分比显著低于对照组(P<0.05)。结论经典原位肝移植术中逆灌注法可减轻移植肝缺血再灌注损伤,改善移植肝早期肝功能。

Objective Study on the influences of injurys by ischemia and reperfusion to retrograde perfusion in orthotopic liver transplantations. Methods Thirty five standard orthotopic liver transplantation patients were randomly divided into experimental group and control group. Retrograde perfusion via caval veins were performed in experimental group (17 cases) and normal reperfusions via portal veins were performed in control group (18 cases). The re-warm ischemia time, ALT, GGT, TB and PT in patients' serum were tested in the two groups respectively at one hour, 1 day, 2, 3, 5 and 7 days after operation. Concentrations of TNF-αand IL-1 in the caval veins were also tested two hours after the grafts transplanted into the patients. The ratio of hydropic degeneration and necrotic hepatocytes were detected under the light microscope and the morphologic changes of hepatocytes were detected under light and electro microscope respectively. Results The re-warm ischemia time of experimental group was remarkably shorter than that of control group(P<0.05). For serum TB, the experimental group was remarkably lower than the control group 1 hour, 1 and 2 days after operation(P<0.05), but there were no significant differences between the two groups 3, 5 and 7 days after operation. For serum ALT, the experimental group was remarkably lower than the control group 1 and 2 days after operation(P<0.05), but there were no significant differences between the two groups 1 hour, 3, 5 and 7 days after operation. For serum GGT, the experimental group was remarkably lower than the control group 1hour, 1and 3 days after operation(P<0.05), but there were no significant differences between the two groups 2, 5 and 7 days after operation. For PT, there were no significent differences between the two groups after operation. Concentrations of TNF-αand IL-1 in the caval veins of experimental group were remarkably lower than those of control group two hours after the grafts transplanted into the patients(P<0.05). The injury by ischemia and reperfusion, ratio of hydropic degeneration and hepatocyte necrosis for experimental group were remakably lighter than control group(P<0.05). Conclusion The injurys caused by ischemia and reperfusion might be reduced and the graft functions might be improved by using method of retrograde perfusion in orthotopic liver transplantations.