应用磁性吻合技术进行犬肝移植的大血管重建

Great vascular reconstruction in canine liver transplantation with magnetic anastomosis technique

目的:改进经典式肝移植术中大腔静脉及门静脉重建方法,观察该方法对提高吻合速度与质量、缩短无肝期、减少无肝期对机体的严重影响及缩短手术时间的效果。方法:实验于2005-02/2006-03在西安交通大学第一医院动物外科完成。①32只杂种犬随机分为供受体各16只,进行经典式原位肝移植。②在不使用静脉转流的情况下,利用氧化钛涂层磁环进行大血管的快速重建,在供肝修整时选用相应口径的磁环将血管断端外翻套入磁环,然后荷包缝合固定。③在受体肝脏游离切除以后,将相应口径的磁环套入血管断端,使用尖镊子外翻固定。④检查血管方向,然后快速对合,开放血流。⑤如果发现吻合口扭曲,可以轻度旋转磁环进行调整,至最佳位置。⑥观察受体总手术时间及肝上、肝下下腔静脉及门静脉吻合时间、术中血流动力学变化、吻合口情况及肝移植术后存活情况。结果:预实验选用犬12只,正式实验20只,进入结果分析20只。①手术时间:受体犬总手术时间(3.24±0.49)h,其中无肝期(5.89±2.27)min,肝下下腔静脉吻合时间约(3.89±0.73)min。②血流动力学:受体犬在不使用静脉转流的情况下术中血流动力学稳定,不用升压药,平均补液(730.56±150.56)mL。③吻合口情况:血管吻合口通畅无狭窄,均无渗血,少数扭曲吻合口通过轻度旋转磁环予以纠正,术后均无血栓形成,术后27d愈合良好。④术后存活情况:正式实验手术10例,存活9例。结论:使用磁环进行犬肝移植大血管重建,吻合过程简便,无肝期明显缩短。但是有异物存留体内的缺点,临床应用有待进一步研究。

AIM： To observe the effects of large caval vein and portal vein reconstruction method in typical canine liver transplantation after improving these methods on improving anastomosis speed and mass, shortening anheptic phase and reducing the severe effect of anheptic phase on body and shortening operative duration. METHODS： The experiment was conducted in Department of Animal Surgery of the First Hospital of Xi＇an Jiao Tong University from February 2005 to March 2006. ①Thirty-two adult mongrel dogs were used for typical orthotopic liver transplantation. They were selected as 16 donors and 16 receptors randomly. ②Magnetic rings with titanium oxide coating were used for vascular anastomosis rapidly without veno-venous bypass. In the donors, the broken ends of vessels were fixed by purse string suture after corresponding magnetic rings were inserted into the purse through vascular ecstrophy. ③In the receptors, contesponding magnetic rings were inserted into the broken ends of vessels, and fixed with nipper ecstrophy after receptor liver liberation excision. ④ The magnetic rings were connected rapidly and blood flew after checking the vascular direction. ⑤ The twisted stomas could be corrected by revolving the magnetic rings to a optimal position if there was stoma twist.⑥entire operative period, the anastomosis time of superaheptic and infraheptic inferior vena cava and portal vein, change of hemodynamics in operation, stoma status and survival situation after liver transplantation were observed. RESULTS： A total of 12 dogs were selected in preliminary experiment and 20 in the formal experiment, so 20 dogs were involved in the result analysis. ①Operation time： The entire operative period was （3.24±0.49） hours,the anhepatic phase was only （5.89±2.27） minutes and infrahepatic vena cava anastomosis time was （3.89±0.73） minutes. ②Haemodynamics changes： Haemodynamics was stable without vein bypass and no pressor agent, and fluid replacement averagely （730.56±150.56） mL.③Stoma status： All stomas had no stenosis, errhysis, twist. The twisted stomas could be corrected by revolving the magnetic rings slightly. No thrombogenesis, the healing was good at day 27 after operation. ④Post-operative survival situation： Nine of 10 dogs in experiment were survived. CONCLUSION： Using magnetic rings for large vascular reconstruction in canine liver transplantation is simple, and the anhepatic phase is shortened obviously. But the magnetic rings are left in canine body, more research should be done before the technique used for clinical liver transplantation.