大鼠两种不同供肝对原位肝移植术中和术后影响的比较

Comparison of the results in rat orthotopic liver transplantation from two different donors

目的 比较正常 (HB)和心跳停搏 (NHB)供肝对大鼠原位肝移植术中和术后的影响。方法 雄性SD大鼠随机分成HB和NHB两组 ;NHB组又分别设心跳停搏 30min(HNB - 30 )和 4 5min(NHB - 4 5 )两组。每组各行原位肝移植 5 0、30和 30次。结果 HB和NHB组冷缺血、无肝期、肝下下腔静脉 (IVC)阻断、受体手术时间分别为 (6 9.76± 1.5 2 )min和 (70 .32± 1.5 3)min、(16 .4 6± 0 .96 )min和(16 .4 0± 0 .73)min、(2 2 .5 6± 1.73)min和 (2 2 .75± 1.16 )min、(89.38± 3.75 )min和 (90 .5 8± 3.76 )min ;术后受体苏醒和主动饮水时间分别为 (5 .4 3± 3.88)min和 (5 4 .0 6± 5 .99)min、(43.0 4± 10 .19)min和(12 6 .79± 15 .0 2 )min ;受体术后鼻粘膜出血率分别为 4 .17%和 92 .6 8% ;受体第 1周体重下降幅度分别为 (6 .15± 1.92 ) %和 (9.6 2± 1.80 ) % ;第 2周体重增加幅度分别为 (7.4 4± 2 .5 9) %和 (3.16± 1.0 4 ) %。HB组近期死因分别为原发性移植肝无功能 (PGF)、麻醉过深、肺部感染和肝上下腔静脉 (SVC)吻合口漏 ;而NHB组分别为PNF、麻醉过深、无肝期较长 (>17min)和再灌注后供肝渗血 ;HB和NHB - 30、NHB - 4 5组术后 1周存活率分别为 90 %、5 0 %和 30 %。结论 NHB较HB术中操作更复杂 。

Objective To compare the results in rat orthotopic liver transplantation from heart-beating (HB) and non-heart-beating (NHB) donors during and after operation. Methods Male SD rats were divided into HB and NHB group randomly; HNB group were subdivided into HNB-30 ( 30 min of non-heart-beating time) and NHB-45 (45 min of non-heart-beating time) group randomly. 50, 30 and 30 cases of liver transplantations were performed in each group. Results In HB and HNB group, cold ischemia time, anhepatic phase, IVC clamping time and operation time in recipient were (69.76±1.52)min vs (70.32±1.53)min, (16.46± 0.96 )min vs (16.40±0.73)min, (22.56±1.73)min vs (22.75±1.16)min, (89.38±3.75)min vs (90.58±3.76)min; consciousness and drinking time of recipient were (5.43±3.88)min vs (54.06±5.99)min, (43.04±10.19)min vs (126.79±15.02)min respectively; the recurrence of nasal bleeding of recipient was 4.17% vs 92.68%; the reduction of weight in recipient 1 week after operation was (6.15±1.92)% vs (9.62±1.80)%; weight gain 2 week after operation were (7.44±2.59)% vs (3.16±1.04)%. Short-term death reasons after operation in HB group were primary graft non-function (PNF), deep anesthesia, pulmonary infection and SVC anastomotic bleeding, while those in NHB group were PNF, deep anesthesia, prolongation of anhepatic phase and grafted liver bleeding after reperfusion. One-week survival rate was 90%, 50% and 30% in HB, NHB-30 and HNB-45 group respectively. Conclusions Compared with HB, surgical procedure in NHB group is more sophisticated and more accurate during operation; and after transplantation, the complications rate in NHB group is higher than that in HB group, one-week survival rate is lower and the shot-term death causes are different.