非静脉转流下猪原位肝移植术中无肝期前后的管理

THE MANAGEMENTS IN PRE AND POST ANHEPATIC PHASE OF NON-VENOUS BYPASS ORTHOTOPIC LIVER TRANSPLANTATION IN PIGS

目的总结非静脉转流下猪原位肝移植术中无肝期前后监护管理经验;探讨在非静脉转流下建立小型猪原位肝移植模型的可行性,为进一步研究奠定基础。方法在非静脉转流下行10例次同种异体原位肝移植术,观察无肝期前后血流动力学、血气、生化、肝功能变化情况;并观察术中监护管理对手术成功率的影响。结果手术平均时间(186.7±16.4)min,平均无肝期(30.4±2.8)min;在无肝期前后血流动力学和代谢发生急剧变化;出现明显的代谢性酸中毒、低血糖;供肝复流后出现一过性的高钾血症和酸中毒;在新肝期肝功能出现短暂性损伤。术后5 h左右清醒排便,术第2天开始饮食。结论非静脉转流下猪原位肝移植无肝期前后受体经历了急剧的病理生理学变化,严密观察和维护无肝期血流动力学及代谢稳定是非静脉转流下猪原位肝移植成功的关键因素之一。

Objective To sum up the experience of the pre and post anhepatic phase managements of non - venous bypass orthotopic liver transplantation in pigs; to investigate the feasibility of non - venous bypass orthotopic liver transplantation in mini pigs and pave a way for further research. Methods Orthotopie liver transplantation were performed on 10 pigs, the changes of hemodynamies, blood gas analysis, electrolyte and liver function in both pro and post anhepatic phase were observed; the effects of those managements during operation on success rate of operation was evaluated as well. Results The average time of operations was 186.7 ± 16.4 minutes, the average time of anhe- patic phases was 30.4 ± 2.8 minutes; dramatic changes of hemodynamies and metabolism was observed in pre and post anhepatic phase, including metabolic acidosis, hypoglycemia, transient hyperkalemia and transient liver dyfunc- tion in neohepatic phase. Pigs regained consciousness and defecated in 5 hours after operation, start eating in next day. Conclusion Dramatic pathophysiology changes occur in both the pro and post anhepatic phase, close observa- tion and keep both hemodynics and metabolism in anhepatic phase in stable situation is one of the keys to achieve pigs＇ non -venous bypass orthotopic liver transplantation operations success.