异位肝中叶移植实验研究

HETEROTOPIC HEPATIC SEGMENTS IIW Ⅴ Ⅷ TRANSPLANTATION IN PIGS

目的探讨异位肝移植的最适手术模式方法20只杂种猪,体重25-30kg,随机行供受体配对,供体手术包括供肝切除,4℃ Collins 灌洗,切除供肝左外叶和右后叶,在肝静脉入口上2-3mm 切断肝上下腔静脉等步骤:受体手术包括建立右肝下空间,尽可能靠近尾状叶的供受体下腔静脉端侧吻合,门静脉端侧吻合,肝动脉片腹主动脉吻合,胆总管十二指肠端侧吻合等步骤。结果因门静脉栓塞死亡2只,因胆瘘和腹腔感染死亡2只,活杀2只,4只存活1-2个月后死于急性排斥反应。结论异位肝中叶移植术式不受腹腔容纳的限制,集中了门静脉的血供,尽可能减少了下腔静脉压力梯度的影响,是一个可供临床医生参考蹬手术模式。

objective:To investigate altenative techniques of heterotopic partial liver transplantation.Methods:20 pigs,weigh-ing 25-30kg,were randomly allocated to donors and recipients.The donor liver was obtained and perfused with Collins solution at 4℃.The segments Ⅱ Ⅲ Ⅵ Ⅶ were removed and the suprahepatic portion of the vena cava attached to the graft was shortened to a length of2 to 3 mm above the liver capsule.The graft of segments Ⅰ Ⅳ Ⅴ Ⅷ was placed in the right subhepatic region。The suprahepatic portionof the graft inferior vena cava was anastomosed to the suprarenal vena cava of the recipient。An end-to-side anastomosis between thep-ortal vein of the graft and that of the recipient was made.The hepatic artery(with the patch to theaorta attached)was anastomosed tothe infrarenal aorta of the recipient.Drainage of bile wasrestored between the common bile duct and the duodenum。Rsults:4pigs died,2 owing to portal vein thrombosiss,2 owing to bile peritonitis。2pigs were killed。4 pigs died between land 2 months due to allograft re-jection。Coclusion:Heterotopic hepatic segments Ⅰ Ⅳ Ⅴ Ⅷ transplantation may be a practical operation.