猪原位肝移植体外静脉转流中门脉系统插管的选择

Selection Cannula Vessel of Portal Venous System in Extracorporeal Venous Bypass of Swine Orthotopic Liver Transplantation

目的 比较在猪原位肝移植体外静脉转流中行门静脉插管或脾静脉插管对血流动力学的影响。方法 选健康美国杜洛克猪60头,配对施行原位肝移植术,根据术中转流时门脉系统插管的不同,随机分为两组,即门静脉插管组(n=15)和脾静脉插管组(n=15)。术中连续监测两组动物血流动力学指标的变化。结果 门静脉插管组15例中死亡2例,其中1例死于术中转流不畅,1例死于DIC; 脾静脉插管组15例中死亡1例,死于失血性休克。脾静脉插管组无肝期为(44.5±7.6) min,明显短于门静脉插管组的(51.5±8.7) min。Ⅲ、Ⅳ期门静脉插管组血流动力学改变与脾静脉插管组相比差异有显著性意义(P<0.05)。结论 在猪原位肝移植体外静脉转流中采用脾静脉插管转流能缩短无肝期,保持术中血流动力学的相对稳定,减少术后相关并发症的发生,是一种有效的静脉转流途径。

Objective To compare the hemodynamic changes during operation of portal venous intubation or splenic venous intubation in extracorporeal venous bypass of swine orthotopic liver transplantation.Methods Thirty couples of healthy Duloke pigs were selected to perform orthotopic liver transplantation. According to the difference of cannula vessel of portal venous system during extracorporeal venous bypass, these pigs were divided into two groups: portal venous intubation group ( n =15) and splenic venous intubation group ( n =15). Hemodynamic changes were monitored continuously.Results Two recipients died in portal venous intubation group, one died of unsmooth bypass in the operation, the other died of DIC. In splenic venous intubation group there was only one recipient death, who died of hemorrhagic shock. The time of anhepatic phase of splenic venous intubation group was (44.5±7.6) min, it was significantly shorter than portal venous intubation group(51.5±8.7) min( P <0.05). Hemodynamic changes in phase Ⅲ and phase Ⅳ of portal venous intubation group were significantly different with that of splenic venous intubation group( P <0.05). Conclusion Application of bypass through splenic venous intubation during extracorporeal venous bypass of swine orthotopic liver transplantation can shorten the time of anhepatic phase, keep the hemodymamics relative stable in operation, and reduce the occurrence of postoperative correlative complication. It is an effective veno venous bypass pathway.