猪原位肝移植术中体外静脉转流途径的实验研究

Extracorporeal Venous Bypass in Porcine Orthotopic Liver Transplantation: A Comparative Study

目的 探讨猪原位肝移植手术中体外静脉转流的应用及不同转流途径对血流动力学的影响。方法 选择50只健康家猪按体重接近原则配对分为供体组与受体组进行 2 5例原位肝移植手术 ,受体组无肝期采用不同体外静脉转流途径 ,其中A组 (1 6只 )经门静脉插管 ,B组 (9只 )经脾静脉插管。术中连续监测A、B两组动物的血流动力学变化。结果 术后 2 4h ,A组存活 1 4只 ,B组 9只全部存活。A组血流动力学在无肝期开始及结束时均出现明显波动 ,平均动脉压和中心静脉压下降 ,心率上升 ;B组在整个无肝期内血流动力学保持平稳 ,两组间比较差异有显著性意义 (P<0 .0 5)。结论 猪原位肝移植术中应用体外静脉转流 ,有利于维持血流动力学稳定 。

Objective To explore the application of extracorporeal veno venous bypass in orthotopic liver transplantation in pigs and to compare hemodynamic changes during operation of two different bypass ways. Methods Twenty five porcine orthotopic liver transplantations were performed and extracorporeal veno venous bypass was established during anhepatic phase through a catheter in portal vein (group A, n =16) or in splenic vein (group B, n =9).Hemodynamic changes were monitored continuously.Results Fourteen recipients survived two days after operation (14/16) in group A while all survived in group B (9/9).Transient hemodynamic disturbance (MAP and CVP decreased,and HR increased) was monitored at both the beginning and the end of anhepatic stage in group A,while these parameters kept stable in group B ( P <0.05).Conclusion Applying veno venous bypass may stabilize recipients' hemodynamics in porcines orthotopic liver transplantation,and splenic vein draining way has more advantages than portal vein.