小型猪非转流原位肝移植的围手术期处理

The perioperative management of orthotopic liver transplantation in Chinese inbred miniature porcine

目的探讨中国小型猪非转流条件下原位肝移植的围手术期特点，以建立成熟、稳定的移植模型。方法通过预实验组8例次和实验组18例次非转流条件下中国小型版纳猪原位肝脏移植术，观察围手术期血流动力学及重要代谢指标的变化，改进围手术期处理措施，总结围手术期处理特点。结果预实验组8例次均在术后当天死亡。实验组18例次无术中死亡，术后7d存活率为88．9％。实验组平均手术时间（179．6±14．3）min，平均无肝期（27．3±3．4）min。无肝期血流动力学及生化代谢波动明显。术后当天麻醉清醒，术后约3-5h开始自行排尿，术后第3天正常进食。结论手术中无肝期时间的缩短及血流动力学的相对稳定是非转流条件下猪原位肝移植成功的关键。

Objective To summarise the perioperative features of orthotopic liver transplantations （ OLTs ） in miniature porcine, to establish mature, stable OLT models. Methods In order to observe hemodynamics and blood changes and improved perioperative management and summarise the perioperative characteristics, 8 preliminary experiments （group A ） and 18 experiments （group B ） of OLTs were performed without veno-venous bypass （VVB） in Chinese inbred miniature porcine. Results The mean operation time was （179.6± 14. 3） min in our 18 OLTs, and the mean anhepatic phase time was（27. 3 ± 3. 4） min. Dramatic hemodynamic and metabolic changes were identified during anhepatic phase. The one- week survival rate was 88.9 % in group B, but all the 8 pigs in group A died. The experiment group pigs urinated after 3 - 5hours and had normal diet after 3 days. Conclusions Decreasing the operation time and stability of hemodynamics in anhepatic phase are the keys for success in OLTs without VVB.