小型猪原位肝移植模型的建立与评价

A simplified orthotopic liver transplantation technique without WB in pig model

目的 探讨建立放弃静脉转流的小型猪原位肝移植模型的可行性。方法 选用广西巴马小型猪(3-6月龄,8-11kg)为实验动物,共实施原位肝移植10例次。供体肝脏游离、冷灌注、切取、修整以及UW保存按常规方法进行。受体术中肝脏游离后夹闭肝上、肝下下腔静脉和门静脉并切除受体肝脏,各血管断端与供肝相应血管进行端端吻合,肝上下腔静脉和门静脉吻合完毕即开放肝脏血流,在此过程中未使用静脉转流,此后吻合肝动脉、胆管。结果 本组10例次肝移植手术后一周存活率90％(9/10),无肝期时间31.3±2.67min,无肝期血压显著下降(MAP4.5±1.58kPa)但肝血流开放后能较快恢复并渐趋平稳。结论 本组结果表明,非静脉转流条件下的小型猪肝移植模型是一操作方便、易于复制同时又具有较好重复性和稳定性的大动物肝移植模型,能应用于肝移植的系列实验研究。

Objective Since clamping of the venous splanchnic system on anhepatic phase is believed to be responsible for high morbidity and mortality in porcine orthotopic liver transplantation (OLT), the usage of venovenous bypass (WB) is advocated. But WB may cause many severe complications even induce the animal to death. In our experiment, a simplified orthotopic liver transplantation technique without WB in pigs has been developed and evaluated in term of morbidity and mortality. Methods 10 OLTs were performed between pairs of Guangxi BAMA miniature swine (3-6 months of age, 8-11 kg). In the donor, freeing of the liver, cold perfu-sion in situ , hepatectomy and preserving of the liver in UW solution were performed by routine method, and 200 ml blood was taken from the donor, preparing to transfuse to the recipient in recipient operation. In the recipient, after total hepatectomy and complete portal and caval clamping, the suprahepatic vena cava and portal vein were sutured without WB, after that, the liver graft was perfused. The infrahepatic vena cava ,liver artery and biliary reconstruction were then performed with end - to - end sutures. Results 9/10(90% ) animals survived more than 1 week. The mean anhepatic time was 31.3 + 2.67 min. Severe hypotension was presented during the anhepatic phase(MAP 4.5+ 1.58 kPa), after graft reperfusion, the hemodynamic status recovered promptly and stabilized gradually. Conclusions It may be concluded that the simplified orthotopic liver transplantation technique without WB in pig model is appropriate and feasible.