猪劈离式原位肝移植动物模型建立及麻醉处理

Establishment of a porcine splitting orthotopic liver transplantation model and management of anesthesia

背景：劈离式原位肝移植技术存在术后胆道并发症发生率高、左内侧叶缺血坏死等问题,为了进一步开展劈离式肝脏移植的研究,需要找到一种适宜的动物,建立稳定的移植及麻醉模型.目的：探讨猪劈离式原位肝移植模型建立及其术中麻醉处理特点.方法：40只健康3月龄猪,体质量25~30 kg,在气管插管全麻下进行静脉-静脉转流,供肝沿Taira线劈离,对断面修整后,行原位肝脏移植.结果与结论：手术时间（220±31） min,无肝期（35±6） min.术后肝功能恢复顺利,手术成功率50%,10只动物存活时间均超过48 h,无肝期、再灌注期血流动力学波动明显,并伴有代谢性酸中毒;再灌注期血钾升高明显,体温下降明显.结果可见：①猪同种异体原位劈离式肝脏移植模型（沿Taira线）具有操作简便,标准化程度及手术成功率高,重复性和稳定性好的优点,是大动物肝移植系列研究的较理想动物模型.②即使在良好的静脉转流下无肝期、再灌注期血流动力学、内环境变化仍明显,麻醉过程中纠正凝血机制及维持内环境的稳定对手术的成功至关重要.

BACKGROUND： The porcine splitting orthotopic liver transplantation technique is characterized as high incidence of biliary complication and ischemic necrosis of the left medial lobe. In order to further research the splitting liver transplantation, a suitable animal is need to establish the transplantation and anesthesia model. OBJECTIVE： To investigate the establishment of porcine splitting orthotopic liver transplantation model and the characteristics of anesthesia management. METHODS： Forty 3-month-old pigs weighing 25-30 kg were selected, the veno-venous bypass was performed under general anesthesia, and then the donor liver was split along Taira line. After the section was trimmed, the orthotopic liver transplantation was performed.RESULTS AND CONCLUSION： The liver function recovered well, and the survival rate after one week was 50%, the operative time of recipient was （220±31） minutes, the recipient underwent anhepatic period was （35±6） minutes. Ten animals survived more than 48 hours. During anhepatic and reperfusion phase, the hemodynarnics was significantly changed; and in the reperfusion phase, the content of serum potassium was significantly increased while the temperature was decreased. The result indicates that： ①The porcine splitting orthotopic liver transplantation model （along Taira line） is easy to operate, and has highly standardized degree and success rate as well as good reproducibility and stability, which is considered as an ideal animal model for a series of studies of liver transplantation in large animals. ②Even in a good vein bypass, the changes of hemodynamics and environment in anhepatic and reperfusion phase were significant. The correction of clotting mechanism and maintaining a stable internal environment during anesthesia are critical for the success of the operation,