建立猪脾窝异位辅助性活体肝移植的动物模型

Establishment of splenic fossa auxiliary partial heterotopic living donor liver transplantation models in miniature pigs

目的 评价获取活体猪左半肝行脾窝异位辅助性肝移植的可行性.方法 选用体重相近的雌性广西巴马小型猪20头,随机分为供体和受体.切取活体供体猪左半肝（不含肝中静脉）,肝左静脉缝合直径8mm、长2.5cm聚四氟乙烯人工血管做桥接血管.切除受体猪脾和左肾,将供肝置入脾窝,供体肝门静脉左支、肝动脉左支、肝左静脉桥接血管分别与脾静脉、脾动脉和左肾静脉行端端吻合,左肝管插管引出体外.未使用免疫抑制剂,观察术后2周情况及外科并发症.结果 进行10次脾窝异位辅助性活体肝移植,7头供体猪术后存活2周,6头受体猪术后存活2周,仅3头受体猪移植肝功能良好.结论 尽管动静脉血栓栓塞和人工血管血栓形成等并发症发生率较高,获取活体猪左半供肝行脾窝异位辅助性肝移植在技术上是可行的.

Objective This study was performed to develop a clinically relevant porcine model of auxiliary partial heterotopic living donor liver transplantation in splenic fossa.Methods Twenty female Guangxi Bama miniature pigs with similar body weight were randomly divided into donor group （n=10） and recipient group （n=10）.The left hemi hepatic graft without middle hepatic vein was procured from the living donor under the general anesthesia.The liver graft was tailored at the back table;an 8-mm diameter polytetrafluoroethylene graft about 2.5 cm long was connected to the left hepatic vein.The liver graft was implanted in the splenic fossa after splenectomy and left nephrectomy,with a hepatorenal venous anastomosis （via artificial graft）,splenpotal venous anastomosis,and splenohepatic arterial anastomosis in end-to-end fashion,respectively.A polyethylene tube was inserted into the left bile duct branch of the graft and led through the body wall as an external biliary drain.No immunosuppressive drugs were given in this series.Survival rate and complications were observed with 2 weeks after transplantation.Results Ten pig models of auxiliary partial heterotopic living donor liver transplantation were successfully established.Two-week survival rates were 70% and 60% for donors and recipients,respectively.But only three recipients had well-functioning graft livers.Conclusion Despite a high morbidity rates including hepatic artery thrombosis,portal vein thrombosis and artificial graft mural thrombus formation,it is feasible to use left hemi hepatic graft without middle hepatic vein from living donor and splenic fossa auxiliary partial heterotopic liver transplantation in miniature pig.