原位猪肝移植无肝期和再灌注后危险因素研究

STUDY OF DANGEROUS FACTORS DURING ORTHOTOPIC LIVER TRANSPLANTATION IN THE PIGS

目的探讨原位猪肝移植无肝期和再灌注后影响供肝功能和受者存活的危险因素。方法共行35例原位猪肝移植,在移植前、无肝期以及再灌注后2 h检测受体血流动力学、血气、肝功能、肝脏组织病理学以及血清内毒素变化情况。结果受体平均动脉压(MAP)、中心静脉压(CVP)以及心排出量(CO)在无肝期明显下降(与移植前相比,P<0.01)。无肝期同时出现明显的代谢性酸中毒、低血糖、低体温状态。供肝再灌注后出现一过性高血钾,并伴有谷草转氨酶(AST)、总胆红素(TB)明显升高(与移植前相比,P<0.01)。再灌注后肝脏病理改变明显。在良好的体外转流状态下,无肝期及再灌注后血清内毒素、TNF-α值稍有升高,与移植前相比无显著性差异(P>0.05)。结论原位猪肝移植受者在无肝期和再灌注后经历了一系列的病理生理变化,明确以上危险因素的的发生发展,并给予正确的处理,可以极大地提高手术成功率,延长术后存活时间。

Objective To investigate danderous factors during orthotopic liver transplantation in the pigs（POLT） and propose therapeutic measures. Methods 35 cases of POLT were performed. Hemodynamic parameters, blood biochemistry, hepatic function,liver histopathology, and serum endotoxin level were measured in the peri-operation period of POLT. Results Compared with those in the pre-anhepatic stage, the value of MAP, CVP and CO in the anhepatic stage decreased significantly （ P 〈 0. 01 ）. Metabolic acidosis, hypoglycemia and hypothermia occurred in anhepatic stage. Instant hyperkalemia occurred following reperfusion. AST, TB post reperfusion were significantly higher than those in the pre-anhepatic period（P 〈 0. 01 ）. The pathological change of liver was obvious post reperfusion compared with that in the pre-anhepatic stage. The values of endotoxin and TNF-α in serum post reperfusion were slightly higher than those in the pre-anhapatic stage（ P 〉 0. 05 ） with satisfactory veno - venous bypass. Conclusion The recipients of POLT experience a series of pathophysiologic changes. Understanding the above-mentioned dangerous factors and treating them correctly could greatly improve operation success rate and prolong survival time of the recipients.