152例大鼠原位全小肠移植的外科技术总结

Surgical techniques for orthotopic small bowel transplantation in rats:analysis of 152 cases

目的：总结大鼠原位全小肠移植的外科手术方法。方法：雄性F344和Lewis大鼠分别为供体和受体。供肠切取范围包括全小肠、门静脉及肠系膜上动脉。供肠肠系膜上动脉与受体肾下腹主动脉端侧吻合采用连续外翻锁边缝合方法,供体的门静脉与受体的左肾静脉端端吻合采用Cuff套管方法,切除受体自体小肠,断端与供体肠吻合重建消化道。供、受体术中均补液4~6 ml。结果：共进行152次移植手术,其中正式实验120次,供体手术时间（60±10）min,受体手术时间（100±15）min,移植肠热缺血时间（30±5）min,78.3%大鼠术后存活超过2周,病理检查证实移植肠病变符合排斥反应特点。结论：供肠获取、血管吻合术、术中血容量维持、保温是大鼠原位全小肠移植术的关键。

Objective： To review the surgical technique for orthotopic small bowel transplantation in rats.Methods： The male F344 and Lewis rats were donors and recipients,respectively.The entire small bowel,portol vein and superior mesenteric artery were removed in the donors.Small bowel transplantations were performed by microvacular end-to-side anastomosis of the donor superior mesenteric artery,and the recipient infrarenal aorta by continuous lock suture technique and by formation of a ＇cuff＇ anastomosis between the donor portal vein and the recipient left renal vein.The small bowel of the recipient was removed and replaced by the graft.Both the donor and the recipient received intravenous administration of 4~6 ml of lactated Ringer＇s solution during the operation.Results： 152 transplantations were performed,among which 120 transplantations were involved in the experiment group.The operation time for the donor and recipient was（60±10） min and（100±15） min,respectively.The warm ischemia time was（30±5）min.78.3% of the recipients survived over 2 weeks after the operation,and their grafts were harvested for pathological examination.The pathological changes of the grafts were consistent with the features of allograft rejection.Conclusion： Graft harvest,vascular anastomosis,prevention of hypovolemic shock and warm preservation during the operation are the key surgical techniques.