肝动脉补充灌注对供肝胆道微血管影响的实验研究

Effect of adjuvant hepatic artery perfusion on donor biliary microvasculature in dogs

目的通过犬肝移植比较犬肝肾联合切取中经胃十二指肠动脉补充灌注对胆道微血管丛的灌注效果。方法分析传统双通道灌注快速切取法（15例）和加用经胃十二指肠动脉补充灌注肝动脉法（15例）的手术方式以及胆道灌注效果的资料，对两种灌注方法的时间数据及灌注效果进行统计学分析。结果两种方法相比较，手术时间、供肝功能无明显差异，胃十二指肠动脉辅助灌注肝动脉法供体切取时间较长（P〈0．01），但肝动脉灌注维持时间较长（P〈0．01），胆管周围微血管断面内红细胞个数明显减少（P〈0．01），可以有效提高胆道血管丛灌注效果。结论经胃十二指肠动脉补充灌注肝动脉法对胆道微血管丛灌注效果较传统方法更好，可为改进临床灌注方法提供线索。

Objective To get better perfusion effect of donor biliary microvasculature in dogs receiving combined liver-kidney procurement, we compared intragastroduodenal artery adjuvant hepatic artery perfusion method and the conventional method. Methods Thirty dogs received combined liver- kidney procurement. Amongst the 30 dogs, 15 were perfused in abdominal aorta and portal vein conventionally and other 15 cases underwent the same procedure plus intragastroduodenal artery adjuvant hepatic artery perfusion. The two groups were compared in operation time, ischemia time, preparation time of donor, perfusion time and perfusion effect. Results These two methods had no difference in operation times,ischemia time and donor function. However, intragastroduodenal artery adjuvant hepatic artery perfusion could prolong perfusion time and elevated perfusion effect of biliary microvasculature. Conclusion Biliary microvascular perfusion is important. It can decrease the morbidity of ischemic-type biliary lesion （ITBL） in liver transplantation. Intragastroduoden artery adjuvant hepatic artery perfusion has better effect in dog biliary microvascular perfusion. Adjuvant hepatic artery perfusion is fit for donor of long-time preservation and could be used in clinical trial.