无心跳供肝大鼠肝移植模型的手术操作技巧探讨

Surgical Skills of Non-Heart-Beat Liver in Rat Liver Transplantation Model

目的建立一个稳定的无心跳供肝大鼠原位肝移植模型。方法在Kamada"二袖套法"的基础上进行改良,根据供肝获取前经历无心跳热缺血时间不同分为10min(R10组)、20min(R20组)和30min(R30组)3组,比较各组术后1周大鼠存活率。结果供体手术时间约30min(不含热缺血时间)。供肝冷保存时间均为1h。肝上下腔静脉吻合时间12～22min(平均15min),门静脉和肝下下腔静脉套管分别约需2min和1min。无肝期时间14～24min(平均19min),受体总手术时间50～65min(平均60min)。大鼠术后24h内死亡视为手术失败,共计12例死亡。R10组、R20组和R30组手术成功率分别为95%(19/20)、80%(16/20)和65%(13/20),术后1周生存率分别为95%(18/19)、81%(13/16)和54%(7/13)。结论在Kamada"二袖套法"基础上进行改良的大鼠无心跳供肝肝移植模型能很好地模拟临床无心跳供肝肝移植。大鼠肝脏能耐受30min以内的热缺血时间,移植术后短期存活结果满意,长期存活率尚需进一步研究。

Objective To establish a reliable rats model of orthotopic liver transplantation with non-heart beating donors. Methods The model was established with modified double-cuff method. According to obtain pre-liver warm ischemia time experiencing non-heart-beat the rats were divided into 3 groups：10 min （R10 group）,20 min （R20 group） and 30 min （R30 group）,then one week survival after operation was compared in rats. Results The operative time of donor was 30 min approximately except warm ischemia time and the cold preservation time of donor liver was 1 h. The anastomotic time for suprahepatic vena cava was 12-22 min （mean 15 min）. The anastomotic time for portal vein and infrahepatic vena cava was about 2 min and 1 min,respectively. The anhepatic phase sustained 14-24 min （mean 19 min）. The operative time of receptor was 50-65 min （mean 60 min）. Twelve rats died at 24 h after operation,which was considered as operative failure. The success rates of operation in R10 group,R20 group,and R30 group were 95% （19/20）,80% （16/20）,and 65% （13/20）,respectively. After one week the survival rate was 95% （18/19）,81% （13/16）,and 54% （7/13）,respectively. Conclusion s Improved non-heart donor liver transplantation model of rat on the basis of Kamada＇s ＂two-cuff technique＂ acts as a good simulation in clinical non-heart-donor liver transplantation. This study showes that rat liver can tolerate warm ischemia time less than 30 min,the short-term survival after transplantation can reach satisfactory results. However,long-term survival requires further study.