基于反观面“钟摆式”吻合法的小鼠左肺原位移植改良模型(附视频)

A modified mouse model of orthotopic left lung transplantation based on “pendulum” anastomosis of the reverse-view plane(with video demonstration)

目的 本研究从多角度对小鼠左肺原位移植模型进行改进,旨在建立一种更简易、快速和稳定的小鼠肺移植研究模型。方法 基于本团队前期大鼠左肺原位肺移植改良模型,本研究对小鼠左肺原位移植的气管插管、套管制备和受体吻合程序等均进行了不同程度的改进。由1名具有显微外科经验的操作者连续进行40例小鼠左肺原位移植手术。其中,受体肺门结构的游离在肺门钳夹平面的反观面视野下进行,并采用“钟摆式”吻合法依次对肺门三支(左主支气管、肺动脉、肺静脉)逐一吻合。详细记录各移植程序的操作时间。于术后2周处死受体,记录术后并发症的发生情况。结果 40例小鼠肺移植手术均成功完成,术中无支气管和血管撕裂、扭曲,吻合处无渗血。心肺整体获取时间为(10.7±1.5)min,套管制备时间为(16.2±1.5)min,冷缺血时间为(25.1±2.4)min,热缺血时间为(19.4±1.6)min,总手术时间为(57.2±2.9)min。在术后6~14 d的随访过程中,1只受体小鼠死于胸腔积液,考虑为感染所致;其余受体小鼠随访期间均未出现气胸、血栓和肺不张等现象。结论本研究基于反观面“钟摆式”吻合法的小鼠左肺原位移植改良模型具有操作时间短、成功率高和并发症少等优点,有望成为可供选择的肺移植术后病理变化的研究模型,值得进一步推广。

Objective To modify the mouse model of orthotopic left lung transplantation from different perspectives, aiming to establish a simpler, faster and stabler mouse model of lung transplantation. Methods Based on preliminary modified rat model of orthotopic left lung transplantation established by our team, varying extent of modifications were made regarding the tracheal intubation, cannula preparation and anastomosis procedures of orthotopic left lung transplantation in the recipient mice. Orthotopic left lung transplantation in 40 mice were performed by an operator with microsurgical experience. The dissection of the recipient’s hilar structure was carried out at the plane of the hilar clamp model within the reverse-view, and the three branches(left main bronchus, pulmonary artery and pulmonary vein) of the pulmonary hilum were anastomosed in turn by the “pendulum” anastomosis method. The operation time of each procedure was recorded. The recipient mice were sacrificed at postoperative 2 weeks, and the incidence of postoperative complications was recorded. Results Lung transplantation was successfully completed in 40 mice, with no bronchial and vascular tearing or twisting, and no bleeding at the anastomosis site. The overall cardiopulmonary procurement time was(10.7±1.5) min, cannula preparation time was(16.2±1.5) min, cold ischemia time was(25.1±2.4) min, warm ischemia time was(19.4±1.6) min, and the total operation time was(57.2±2.9) min, respectively. During the follow-up from 6 to 14 days after surgery, one recipient mouse died of pleural effusion, probably caused by infection.No pneumothorax, thrombosis or atelectasis was found in the remaining recipient mice during postoperative follow-up.Conclusions The modified mouse model of orthotopic left lung transplantation based on “pendulum” anastomosis of the reverse-view plane possesses multiple advantages of short operation time, high success rate and few complications,which is expected to become an alternative model of studying pathological changes after lung transplantation and worthy of further application.