恒河猴肝移植术后早期腹腔出血的原因

Causes of intra-abdominal hemorrhage in rhesus monkeys after liver transplantation

目的:探讨恒河猴肝移植腹腔出血的原因.方法:实验均为健康的恒河猴,受体为♂,体质量为7.2-11.5kg,供体雌雄不限,体质量5.3-8.1kg;供体采用腹部"十"字形大切口进行快速切取供肝;在修肝时将肝下下腔静脉、门静脉套管和胆道支撑管留置好;受体采用经典式原位肝移植+二袖套法+胆道支撑管建立稳定的恒河猴肝移植模型.观察活动情况、进食饮水情况及对刺激的反应.专人观察术后动物,死亡或者濒临死亡时立即对恒河猴进行解剖,获取标本.结果:成功实施的25对恒河猴肝移植模型中,出现腹腔出血11例,因腹腔出血而死亡5例,死亡率为20%;出血部位的总体分布为门静脉连接处出血5例,肝下下腔静脉连接处出血5例,肝床出血4例,肝上下腔静脉吻合口出血4例,肝脏人为损伤出血3例,肝脏包膜渗血3例,右肾上腺和腰静脉出血2例.结论:恒河猴肝移植术后早期腹腔出血最常见的是肝下下腔静脉和门静脉连接处出血.通过对恒河猴肝移植术后腹腔出血的原因分析,其结果可以指导我们实验手术操作的进一步改进,从而提高恒河猴肝移植模型的实验手术成功率.

AIM： To analyze the causes of abdominal hemor- rhage in rhesus monkeys after liver transplanta- tion. METHODS： Healthy male rhesus monkeys weighing 7.2-11.5 kg were used as recipients, while healthy females or males weighing 5.3-8.1 kg were use as donors. Donor operation was performed quickly by making a big crucial incision in the abdomen. The improved dual-cuff of the portal vein and inferior vena cava was completed except for keeping biliary support tube within the donor liver. Classical orthotopic liver transplantation was performed in recipients. RESULTS： Classical orthotopic liver transplan- tation was successful in all 25 rhesus monkeys. Eleven rhesus monkeys suffered from abdominal hemorrhage in the early postoperative stage, and 5 of them died. The distribution of abdominal hemorrhage site was as follows： anastomotic hem- orrhage of the inferior vena cava in 5 cases, anas- tomotic hemorrhage of the portal vein in 5 cases, anastomotic hemorrhage of the superior vena cava in 4 cases, anastomotic hemorrhage of the liver bed in 4 cases, hemorrhage from mechanical injury in 3 cases, subcapsular hemorrhage of the liver in 3 cases, and hemorrhage of the right suprarenal vein and lumbar vein in 2 cases. CONCLUSION： The most common cause of ab- dominal hemorrhage in rhesus monkeys after classical orthotopic liver transplantation is anas- tomotic hemorrhage of the inferior vena cava and portal vein.