提高大鼠原位肝移植成功率的技术细节及围手术期处理

Surgical techniques and perioperative management for improving the success rate of orthotopic liver transplantation in rats

目的探讨提高大鼠原位肝移植(rat orthotopic liver transplantation,ROLT)成功率的相关技术细节及围手术期处理的正确方法。方法以Kamada建立的"双袖套"法为基础,通过反复练习,逐步改进麻醉、肝上下腔静脉吻合、供肝灌洗、供肝冷保存、术后补液、动物饲养等方法。结果完成ROLT达270余例,建模的学习曲线非常陡峭,分作探索期、突破期、成熟期,手术成功率分别为0%、71.1%、94.5%,后期达到90%以上的成功率。肝上下腔静脉的吻合是大鼠原位肝移植建模过程中最为关键的步骤和难点。结论通过对显微外科技术细节的精益求精的训练及细致的围手术期处理,才能提高ROLT手术成功率和术后存活时间。

Objective To investigate the surgical techniques and appropriate perioperative management for ensuring successful orthotopic liver transplantation （ROLT） in rats. Methods Based on the double-cuff technique of Kamada, we modified the surgical techniques of separation, perfusion and cold preservation of the donor liver, shearing and anastomosis of the suprahepatic vena cava with optimized postoperative infusion protocols and animal care. Results Two hundred and senventy rats underwent ROLT and a learning curve of the success rate was built to reflect the impovment of techniques. The learning curve showed steep improvemts over the exploration stage, breakthrough stage and maturation stage, and the success rates incresed sharply over time （0%, 71.1%, and 94.5%, respectively） until finnally reaching over 90%. The shearing and anastomosis of the suprahepatic vena cava remained the most critical and difficult techniques in ROLT modeling. Conclusion Proficient microsurgical techniques and meticulous nursing can reduce postoperative complications, enhance operational success rate and extend the survival time after ROLT.