改良单人操作大鼠原位肝移植模型的建立

Establishment of Orthotopic Liver Transplantation Model in Rats Using Modified Technique by Single Operator

目的探索改良传统手术方法单人操作大鼠原位肝移植模型的建立方法。方法 200只(100对)大鼠建立原位肝移植模型,其中80只(40对)进行正式实验,采用改良的Kamada二袖套法,再对手术中关键步骤进行改良,并对术中及术后恢复情况进行分析。结果本组80只大鼠原位肝移植手术均顺利完成。供体手术时间为(28.5±2.4)min,供肝修整时间为(10.2±1.8)min;肝上下腔静脉吻合时间为(15.3±1.9)min,门静脉吻合时间为(3.4±1.2)min,受体无肝期为(23.8±1.9)min,肝下下腔静脉吻合时间为(5.1±2.1)min,胆道重建时间为(3.1±0.9)min。整个手术过程中供、受体出血量均不足0.5 ml。40只受体大鼠,术后2 d成活率为90.0%(36/40),3只死于肝上下腔静脉缝合处出血,1只死于无肝期过长;术后7 d成活率为82.5%(33/40),3只均死于腹腔内感染。结论在单人操作建立大鼠原位肝移植模型中,通过腹主动脉和下腔静脉整块游离行腹主动脉灌注供肝、精细解剖左隔下静脉三角、术中热凝控制出血等方面的改良可减少手术并发症的发生,保证供肝质量,提高大鼠成活率。

Objective To explore the surgical techniques of rat orthotopic liver transplantation（OLT） model in rats using modified technique by single operator.Methods A total of two hundreds cases of rats（one hundred pairs） were used to establish OLT model including eighty cases of rats（forty pairs） used in formal study by using modified Kamada ＂two-cuff＂ method,of which the key surgical procedures were further modified.Intraoperative results and postoperative recovery were analyzed.Results All eighty cases of rats successfully operated.Operative time in donors was（28.5±2.4） min and reparative time of donor liver was（10.2±1.8） min.Anastomosis time for suprahepatic inferior vena cava and portal vein（15.3±1.9） min and（3.4±1.2） min,respectively.Anhepatic phase of transplant recipients was（23.8±1.9） min,anastomosis time for infrahepatic inferior vena cava was（5.1±2.1） min,and biliary reconstruction time was（3.1±0.9） min.Blood loss of donor and recipients during the operation was blew 0.5 ml.No recipient died for operation.The 2 d survival rate of recipients was 90%（36/40）,three rats died of bleeding at the seam in hepatic inferior vena cava and one rat died of longer anhepatic phase.The 7 d survival rate of recipients was 82.5%（33/40）,three rats died of intraabdominal infections.Conclusion The modification in en bloc separation of abdominal aorta and interior vena cava for abdominal aortic perfusion of donor liver,careful dissection of left subphrenic vein triangle and the hemostasis by heat coagulating can reduce operative complications,guarantee the quality of donor liver and improve the survival rate of rats in establishment of OLT model in rats using modified technique by single operator.