猪肝移植时无心跳供体耐受热缺血时间的研究

Time limits of tolerance to warm ischemia of liver grafts from non-heart-beating donors in pigs

目的探讨猪肝移植时供肝耐受无心跳热缺血损伤的安全时限。方法对24头小型家猪根据供肝热缺血时间0、15、30、45 min,随机分为4组,而后行原位肝移植,分析移植后肝脏丙氨酸氨基转移酶(ALT)、乳酸脱氢酶(LDH)、三磷酸腺苷(ATP)的含量以及病理变化。结果WI-45组胆管吻合前无胆汁流出。WI-15、30、45组血清ALT、LDH、肝细胞ATP的含量与WI-0组比较,差异有统计学意义(P<0.05),WI-15、30组间差异无统计学意义(P>0.05),但WI-45组与WI- 15、30组比较,差异有统计学意义(P<0.05)。电镜下观察WI-15、30组肝组织呈可复性改变,WI-45组则呈不可逆性改变。结论猪肝移植时,供肝耐受无心跳热缺血损伤的的安全时限为30 min。

Objective To investigate the safe duration limits of tolerance to warm ischemia of liver grafts from non-heart-beating donors （NHBDs）. Methods Twenty-four small pigs were randomly divided into 4 groups： non-heart-beating time for 0 min （WI-0） ,15 min （WI-15） ,30 min （WI-30） ,45 min （WI-45）. The contents of ALT, LDH, ATP and pathological changes were observed after orthotopic liver transplantation. Results The flow of bile was not seen in WI-45 group. Compared with WI-0 group, there was significant difference in serum ALT,LDH,and hepatic ATP in WI-15 group,WI-30 group and WI-45 group （all P 〈 0.05） ,there was significant difference between WI-45 group and WI-15 group,WI-30 group （P 〈0.05） ,but there was no significant difference between WI-15 group and WI-30 group. Under the electronic microscopy,pathological changes in WI-30 group and WI-15 group were recoverable ,but unrecoverable in WI-45 group. Conclusion The safe duration limit of tolerance to warm ischemia of liver grafts from non-heart-beating small pigs is about 30 min.