大鼠心跳停搏供肝在原位肝移植术中损伤的预防

Prevention of injury to non-heart-beating donor liver in rat orthotopic liver transplantation

目的探讨预防和减轻大鼠心跳停搏供肝在原位肝移植术中的损伤,以提高手术成功率。方法雄性SD大鼠随机分为心跳停搏热缺血30min(N-30)和45min(N-45)两组;,每组分别行原位肝移植术30只次。同时,根据是否对供体手术方法进行改进又分为常规组和改良组。结果(1)常规组和改良组的冷缺血时间分别为(70.04±1.48)和(70.36±1.42)min(P>0.05),无肝期均为(16.40±0.73)min,肝下下腔静脉阻断时间均为(22.75±1.16)min,受体手术时间均为(90.58±3.76)min。(2)N-30和N-45常规组分别有5和9只受体术后死于原发性移植肝无功能,而改良组仅为1和2只(40%∶12%,P<0.05);(3)N-30和N-45组因术中分别出现供肝损伤致再灌注后供肝大量渗血、无肝期过长、切除受体肝脏时麻醉过深,而各有5和7,2和1,2和2只受体术后死亡。(4)N-30和N-45组术后1周存活率分别为50%和30%(P<0.05)。结论预防心跳停搏供肝游离时损伤、供肝再灌注后渗血、无肝期过长和切除受体肝脏时麻醉过深是大鼠心跳停搏供肝原位肝移植手术成功的关键。

Objective To investigate how to prevent injury to non-heart-beating donor （NHBD） in rat orthotopic liver transplantation and improve the success rate of operation. Methods Male SD rats were divided into non-heart-beating time 30min （N-30） and non-heart-beating time 45min （N-45） group randomly. Thirty liver transplants were performed in each group. Meanwhile, a routine operation group and a modified operation group were also set up according to the surgical procedure of donor operation. Results （1） In routine operation and modified operation group cold ischemia time was （70. 04 ± 1. 48 ） and （70.36±1.42）min（ P 〉 0. 05） respectively, but anhepatic phase, IVC clamping time and recipient operation time in both groups was （ 70.32 ± 1.53 ） min, （ 16.40 ± 0. 73 ） rain, （ 22.75 ± 1.16 ） rain and （90.58 ± 3.76 ）vain, respectively ; （2） In N-30 and N-45 groups, there were 5 and 9 recipients who died of primary graft non-function （ PGN ） in normal group, but only 1 and 2 recipients, respectively, died of PGN in modified operation group（40% Vs 12% , P 〈0.05）. （3）In N-30 and N-45 groups, 5 and 7,2 and 2,2 and 1 recipients, respectively, died of grafted liver bleeding after reperfusion , deep anesthesia, and prolongation of anhepatic phase. （4） One-week survival rate was 50% and 30% in N-30 and N-45 group respectively （ P 〈 0. 05 ）. Conclusions The key to improve the success rate of rat orthotopic liver transplantation is to prevent these factors, including injury in donor removal, grafted liver bleeding after reperfusion, deep anesthesia, and prolongation of anhepatic phase.