“灌溉法”防治小体积肝移植后门静脉高压

“Irrigation method” in prevention and treatment of portal vein hypertension after small-for-size liver transplantation

目的 探索通过降低小体积肝移植后门静脉高压和门静脉高灌注以改善肝细胞微循环的有效方法.方法 构建两组小体积肝脏移植大鼠模型（n=62）,分别为小体积肝移植对照组（SFS组）和经门静脉肝内门体多孔锥形管分流组（TPIPSS）.记录并分析血流动力学指标、病理学改变、术后并发症及累积生存率.采用t检验对大鼠肝脏再灌注后静脉充盈时间、血流动力学指标进行分析.Kaplan-Meier方法进行生存分析.结果 研究结果显示多孔锥形管的使用可明显延缓小体积肝移植物再灌注后充盈的时间.与SFS组相比,TPIPSS组充盈时间延长4 s.再灌注后90 min内各个时间点,TPIPSS组门静脉压力均低于SFS组.与SFS组小体积肝脏移植物相比,TPIPSS移植物肝脏结构基本正常,无肝窦窦腔充血和窦间隙不规则扩大等表现.移植后并发症,SFS受体大鼠均出现腹水.TPIPSS组无一出现腹水,但50％（5/10）大鼠出现肝性脑病综合征的表现.持续性体温升高超过7d以上者SFS组占10％（1/10）,TPIPSS组为40％（4/10）.多孔锥形管分流组移植物的平均生存时间显著优于SFS组（37.2 ±;23.5）d比（17.7±; 13.5）d,P＜0.05.结论 多孔锥形管经门静脉肝内门体分流是缓解小体积肝移植后门静脉高压和改善肝细胞再灌注的一种切实有效的方法.

Objective To investigate effective approach to decrease portal venous hypertension and high perfusion of portal vein caused by small-for-size （SFS） liver graft transplantation with the aim of improving hepatocellular microcirculation.Methods Rat models with SFS liver graft （n =62） were well estab lished and divided into SFS group and trans-portal intrabepatic portosystemic shunt （TPIPSS） group.Hemodynamic parameters,histopathologically morphologic changes,postoperative complications,accumulated survival rate were recorded and analyzed.Venous filling time after liver reperfusion,hemodynamic parameters were evaluated using t test and Kruskal-Wallis test.Kaplan-Meier method was performed for survival analysis.Results Venous filling time after liver reperfusion was remarkably prolonged with the application of multihole cone-shaped tubes.Compared with SFS group,the filling time was 4-second longer in TPIPSS.At each endpoints of reperfusion within 90 mins,the portal vein pressures were lowered in the TPIPSS group than those of SFS group.Liver grafts were present with more regular structures in TPIPSS group,with no sign of hepatic sinusoid congestion or irregular clearance extension.In the aspect of postoperative complications,all the rat receivers showed ascites in the SFS group.Nevertheless,there was no ascites observed in TPIPSS rats,and 50% rats （5/10） experienced clinical manifestations of hepatic encephalopathy.Persistent fever over 7 days was showed in 10% rats （1/10） of SFS group and 40% rats （4/10） of TPIPSS group,respectively.The mean survival was superior in TPIPSS group （37.2 ±; 23.5） d than SFS group （17.7 ±; 13.5） d,P 〈 0.05.Conclusion TPIPSS could be a safe and feasible approach to improve portal venous hypertension caused by SFS liver graft and hepatocellular reperfusion.