改良Kamada法大鼠肝移植并发症的常见因素及预防

The complication and prevention of recipient rat received liver transplantation by modified Kamada method

目的:探讨改良Kamada法制作大鼠原位肝移植模型过程中常见并发症的原因及预防措施。方法:对改良法大鼠原位肝移植并发症的原因及预防措施进行回顾性总结分析。结果:(1)采用改良的"二袖套法"对113只大鼠进行原位肝移植预试验(共56对,一只供体大鼠因供肝严重脂肪肝而终止实验),其中存活1周12例,1周内死亡44例,最长存活时间3天。死亡原因:腹腔出血14例,无肝期时间过长10例,肝下下腔静脉狭窄血栓形成5例,门静脉狭窄血栓形成4例,麻醉过深4例,胆管梗阻4例,呼吸衰竭2例,感染1例。(2)在预试验的基础上,我们对110只大鼠行原位肝移植(共55对),其中5例死亡,成功率为90.9%。引起死亡原因有:腹腔出血1例,肝下下腔静脉狭窄血栓形成1例,左膈下静脉出血1例,门静脉狭窄血栓形成1例,麻醉过深1例。试验组的55例大鼠手术成功率和1周存活率为90.9%。结论:(1)重视早期动物模型的预试验操作,细致熟练的显微外科技术是预防术中、术后并发症的先决条件;(2)麻醉的深浅控制是手术成功的保障;(3)尽量缩短受体无肝期是决定术后生存率的关键;(4)改善术后饲养环境及合理的抗菌素应用是预防术后感染的必要手段。

Objective： To investigate the causes of death of recipient rats received orthotopic liver transplantation adopting modified Kamada method and explore the corresponding preventive measure. Methods： Retrospective analysis was carried out on model rats received orthotopic liver transplantation adopting modified Kamada method, for detecting of the causes of death of animals and exploring of preventive measures. Results：In preliminary test team involving 113 rats, in which animal received improved two-sleeve method for orthotopic liver transplantation, 44 rats died during and after transplantation, because of bleeding of abdominal cavity （14 rats）, the long anhepatic phase（10 rats）, infrahepatic vena cava constriction and thrombosis （5 rats）, portal vein constriction and thrombosis （4 cases）, excessively deep anesthesia （4 rats）, biliary obstruction （4 rats）, infection （1 rats）, and respiratory failure （2 rats）. In test team involving 110 rats, 5 animals died during and after transplantation, for bleeding of suprahepatic inferior vena cava （1 rats）, infrahepatic vena cava constriction and thrombosis （1 rats）, portal vein constriction and thrombosis （1 rats）, bleeding of left subphrenic vein （1 rats） and excessively deep anesthesia （1 rats） respectively. Conclusions：The sophisticated microsurgical technique and the delicate surgical manipulation are important in preventing operative complications, while the short anhepatic phase, proper anesthesia, well operation condition, and reasonable use of antibiotics are necessary for animal survival.