单人直视下大鼠肝移植模型供肝获取不同灌注方式比较

Comparison between different perfusion methods for donor liver acquisition in rat liver transplantation model under direct vision of single operator

目的单人直视下建立大鼠肝移植模型,并探讨不同灌注方法对供肝质量的影响。方法在Kamada建立的"二袖套法"基础上改进手术细节,建立大鼠肝移植模型。根据不同的灌注方式将受体大鼠分为A(经腹主动脉灌注)、B(经门静脉灌注)两组。比较两组的灌注效果、手术时间、手术成功率、术后肝功能、肝脏移植物病理学表现及生存情况等。结果灌注完成后,B组肝血窦内残留红细胞较A组多。A组在供肝灌注时间及供体手术时间上均较B组时间长,差异均有统计学意义(均为P<0.01)。A、B两组手术成功率分别为77%和71%。大鼠肝移植术后3 d,两组受体丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TB)水平均较正常值明显升高;术后7、30 d,与A组比较,B组ALT、AST、TB水平均明显升高,差异均有统计学意义(均为P<0.01~0.05)。肝脏病理学检查提示B组肝脏炎症反应程度及肝组织破坏程度均较A组严重,但两组的术后长期生存率差异无统计学意义。结论经腹主动脉灌注大鼠肝移植模型虽稍延长了灌注时间及供体手术时间,但灌注效果更佳,可减轻术后肝组织损伤,使肝功能更快地恢复正常水平。

Objective To establish a rat liver transplantation model under direct vision of single operator and to explore the effect of different perfusion methods on the quality of the donor liver.Methods On the basis of the"two-cuff method"established by Kamada,the operation details were improved to established the rat liver transplantation model.The recipient rats were divided into two groups according to different perfusion methods,group A(perfusion via abdominal aorta)and group B(perfusion via portal vein).The perfusion effect,operation time,operation success rate,postoperative liver function,liver graft pathological manifestations and survival were compared between the two groups.Results There were more residual red blood cells in sinus hepaticus in group B than in group A after perfusion.Both the donor liver perfusion time and donor operation time were longer in group A than those in group B,and the differences were statistically significant(both P<0.01).The success rate of operation in group A and group B was 77%and 71%,respectively.At 3 d after liver transplantation in rats,the levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST)and total bilirubin(TB)of the rats in the two groups were significantly higher than normal.At 7,30 d after operation,compared with group A,the levels of ALT,AST and TB in group B were significantly increased,and the differences were statistically significant(all P<0.01-0.05).The liver pathological examination showed that the degree of inflammatory reaction in the liver and degree of destruction of liver tissue in group B were more severe than those in group A,but there was no significant difference in long-term survival rate between the two groups.Conclusions Although the perfusion time and donor operation time of rat liver transplantation model were slightly prolonged by means of abdominal aorta perfusion,the perfusion effect was better,which can reduce liver tissue damage after operation and restore liver function to normal levels more quickly.