原位肝移植逆行灌注法减轻肝脏缺血再灌注损伤的作用机制

Mechanism of reducing ischemia-reperfusion injury in orthotopic liver transplantation retrograde perfusion method

自20世纪50年代提出肝移植设想以来,经过动物实验阶段、临床试用及临床应用阶段,肝移植已逐步发展为一种临床广泛应用的外科技术,成为公认的终末期肝病常规而有效的治疗手段.临床肝移植中,移植肝的缺血再灌注损伤难以避免,是引起术后肝功能不良的重要因素.此外,肝移植术中血液动力学的剧烈波动和内环境紊乱对预后亦有影响.如何减轻移植肝缺血再灌注损伤、改善术中血液动力学变化是临床肝移植的研究热点.近年的研究表明,经典原位肝移植术中逆行灌注法能有效减轻移植肝的缺血再灌注损伤,改善移植术后的早期肝脏功能,从而有效提高肝移植的成功率和生存率.

Since 1950s,the idea of liver transplantation （LT） was proposed,the technique of LT had been gradually and widely applied in the field of surgery.The development of LT experienced three stages,including animal experiment,clinical probation and clinical application.It is well known that LT is the only effective therapeutic method for terminal stage of liver diseases.In liver transplantation,the ischemia-reperfusion injury is difficult to avoid,and an important factor causing poor liver function.Meanwhile,hemodynamic volatility and internal environment disorder are important prognostic factors.How to reduce ischemia-reperfusion injury of the transplanted liver and improve intraoperative hemodynamic changes in liver transplantation is a clinical research focus.Recent studies has indicated that orthotopic liver transplantation retrograde perfusion method can effectively reduce the transplanted liver ischemia-reperfusion injury and improve liver function early after transplantation,and thus significantly improve the success rate of liver transplantation and survival.