大鼠原位节段小肠移植模型的改进

目的 建立一种简便、稳定的大鼠原位节段小肠移植模型.方法 供、受体均为雄性SD大鼠,各40只,采用供体肠系膜上动脉-腹主动脉漏斗状袖片与受体肾下腹主动脉端侧吻合,供体门静脉与受体左肾静脉Cuff套管袖套吻合.切除受体大部分小肠,供体小肠近、远端分别与受体残留小肠近、远端行端端吻合.结果 供体手术时间(40 ±5)min,受体手术时间(50 ±8) min.热缺血时间(5±2)min,冷缺血时间(15±5) min.动脉吻合时间(5±2)min,静脉吻合时间(4 ±2)min.90.0％ (36/40)的大鼠术后存活时间＞10d.结论 该模型操作简便,手术时间短,模型成活率高,稳定性好.     

大鼠原位小肠移植模型的建立与改进

目的探讨建立一种简便稳定存活率高的大鼠原位小肠移植模型。方法整块切取带有腹主动脉和肠系膜上静脉并门静脉的节段小肠,术中原位冷灌注,4℃乳酸林格液保存。动脉吻合采用显微外科技术行供体腹主动脉对受体腹主动脉的端侧吻合,利用Cuff套管技术将供体的门静脉与受体的左肾静脉端端吻合。移植肠远、近端分别与受体肠行端端吻合。结果建立小肠移植模型1 6次,动脉、静脉吻合时间分别为(2 5±5)m in和(4±1)m in。1 6只受体鼠中1 3只存活超过5 d,平均存活(1 0.3 5±2.8 4)d,最长存活时间为2 1 d。结论移植肠的获取、血管吻合技术、肠吻合技术和维持良好的血容量是手术成功的关键。该模型的成功建立,为小肠移植的基础研究提供了良好的动物模型。     

大鼠小肠移植模型的改进

目的　通过改进技术 ,建立一种简便稳定存活率高的大鼠异位节段小肠移植模型。方法　“无损伤”游离 ,原位冷灌注 ,切取带有腹主动脉和肠系膜上静脉并门静脉的节段小肠 ,4℃乳酸林格氏液保存 1h。游离受体左肾静脉 ,切除左肾。采用显微外科技术行供体腹主动脉对受体腹主动脉的端侧吻合 ,门静脉与受体左肾静脉行袖式吻合。移植肠近端关闭 ,远端外置。结果　共进行 87次移植实验 ,其中 2 6次为正式实验。动脉、静脉吻合时间分别为 2 5～ 30min和 5min。 2 6只受体鼠中2 1只存活超过 3d ,平均存活 (8.93± 2 .5 9)d ,最长存活时间为 14d。结论　良好的血管吻合和充分补充液体是手术成功、移植肠具有良好活力的关键因素     

小鼠异位小肠移植模型的建立

目的 探讨稳定的小鼠异位小肠移植模型制作方法,为小肠移植排斥反应的研究提供良好的实验工具.方法 选用C57BL/6小鼠作供体和BALB/c小鼠作受体进行同种异基因型异位节段性小肠移植.采用小肠供体的门静脉与受体下腔静脉端侧吻合,供体带主动脉片的肠系膜上动脉与受体腹主动脉端侧吻合,供体近端肠管结扎,远端与受体空肠端侧吻合的方式建立异位小肠移植.术后禁食3天,不禁饮,每天分两次经皮下分别给予5%葡萄糖生理盐水2 mL,术后不使用抗生素和免疫抑制剂.小鼠存活超过5 d视为手术成功.结果 共行小肠节段性移植30例,术后5 d存活率达70%(21/30).供体手术时间(41±5.5)min,热缺血时间约0.5 min,供体肠段肠系膜上动脉组织片修整时间约为3 min,供体冷保存时间为(30±7.5)min,受体手术时间(90±7.5)min,其中腹主动脉及下腔静脉阻断时间为(40±3.0)min,静脉吻合时间(10±2.0)min,动脉吻合时间(15±2.5)min,成活小鼠受体手术平均出血量约0.2 mL.手术失败的9例小鼠的死亡原因为动脉吻合口部位狭窄及吻合口处血栓形成(6例),吻合口出血导致出血性休克(2例)和术后腹腔内感染(1例).结论 良好的供体肠段的获取、高质量的血管吻合和肠道吻合及供、受体补液是提高小鼠小肠移植手术成功率的关键.     

门脉建立侧袖式大鼠肝/小肠整块联合移植模型

目的 建立大鼠肝、小肠整块联合移植模型.方法 用Wistar大鼠行同种异体肝、小肠整块联合移植.肝肠联合移植整块切取移植物时,保留门静脉完整性,利用供体腹段下腔静脉在门静脉侧壁上建立一侧袖,并安置套管.然后按kamada二套管法行原位肝移植,动脉重建通过供体腹主动脉与受体腹主动脉行端侧吻合以建立肠系膜上动脉及肝固有动脉血供.回肠末端在右下腹造瘘.结果 手术成功率为86%,动物平均存活时间大于30 d.病理组织学检查发现移植肝和小肠结构正常.结论 用门脉建立袖套式血管吻合技术施行大鼠肝、小肠整块联合移植模型是可行的.     

大鼠辅助性肝-小肠联合移植模型

目的　介绍一种新的大鼠辅助性肝 -小肠联合移植模型。方法　整块切取全部小肠和6 0 %的肝脏。同时切取腹腔动脉及肠系膜上动脉的动脉段以确保移植器官的血供。供体小肠的静脉血通过供体完整的门静脉回流。将供体左肾静脉水平肝下下腔静脉斜形切断吻合于受体两肾静脉之间的下腔静脉 ,供体腹主动脉和受体腹主动脉端侧吻合。切除受体的小肠 ,通过小肠端 -端吻合重建肠道。结果　整个手术时间平均为 130min。 3个月的生存率为 8% (16 2 0 )。移植后 90d ,对 3只大鼠行剖腹探查及组织学检查 ,观察到移植物的形态及功能均正常。观察移植后 12个月的 5只大鼠 ,肝功能正常 ,移植肝及小肠均呈正常的组织学结构。结论　大白鼠辅助性肝 -小肠联合移植是可行的。     

大鼠异位节段小肠移植模型的建立

目的建立大鼠异位节段小肠移植模型。方法对100只雄性SD大鼠施行50次异位节段小肠移植，采用肠系膜上动脉-腹主动脉端侧吻合以及门静脉-左肾静脉套管吻合重建供肠血管，远端肠管腹壁造瘘。结果预实验阶段移植25只，存活3只，成功率12％；正式实验阶段25次手术，成功21次，成功率84％；供体手术时间（60±5）min，移植肠修整时间（15±5）min，受体手术时间（100±10）min。结论大鼠小肠移植中注重手术操作中的细节问题是建立稳定模型的关键。     

大鼠辅助性肝—小肠联合移植模型

目的 介绍一种新的大鼠辅助性肝－小肠联合移植模型。方法 整块切取全部小肠和60％的肝脏。同时切取腹腔动脉及肠系膜上动脉的动脉段以确保移植器官的血供。供体小肠的静脉血通过供体完整的门静脉回流，将供体左肾静脉水平肝下下腔静脉斜形切断吻合于受体两肾静脉之间的下腔静脉，供体腹主动脉和受体腹主动脉端侧吻合。切除受体的小肠，通过小肠端－端吻合重建肠道。结果 整个手术时间平均为130min。3个月的生存率为8％（16／20）。移植后90d，对3只大鼠行剖腹探查及组织这检查，观察到移植物的形态及功能均正常。观察移植后12个月的5只大鼠，肝功能正常，移植肝及小肠均呈正常的组织学结构。结论 大白鼠辅助性肝－小肠联合移植是可行的。     

大鼠异位节段小肠移植模型建立技术的改进

目的：建立大鼠异位节段小肠移植模型。方法：对40例（80只）Wistar大鼠施行异位小肠移植,供受体术前抗生素灌胃,改变供受体术式,减少受体手术时间、手术损伤及供肠缺血时间;采用腹主动脉-肠系膜上动脉吻合以及左肾静脉-门静脉单套管吻合,血管吻合方法采用单纯间断吻合,重建供肠血管;移植小肠双造口,静脉补液通路采用股静脉。结果：肠缺血时间≤35min,吻合口无狭窄,40例大鼠接受小肠移植,建模成功35例。结论：改进小肠移植技术中的多个细节后,降低了大鼠小肠移植术的难度。     

三袖套血管吻合法行大鼠异位小肠移植

目的改进大鼠小肠移植血管吻合术式,以缩短移植肠缺血时间,简化手术操作,提高手术成功率。方法动脉吻合采用供者带肠系膜上动脉的腹主动脉段两端与受者的腹主动脉袖套吻合,静脉吻合采用供者的门静脉与受者的左肾静脉袖套吻合,即三袖套吻合法。结果共进行70次手术,成功65次,手术成功率92.9%;整个手术用时2～3h,其中动脉吻合用时(5±2)min,静脉吻合用时(2±1)min,动静脉吻合用时(8±2)min。结论三袖套血管吻合法可简化大鼠小肠移植手术,缩短手术时间。     

Simplified techniques in rat heterotopic small bowel transplantation

AIM: Establish a simplified heterotopic small bowel transplantation (SBT) in the rat. METHODS: Ninety pairs of male Wistar rats were used as donors and recipients. The whole small intestine with a vascular pedicle composed of superior mesenteric artery (SMA) and portal vein (PV) was harvested as the graft. Revascularization was accomplished by end-to-side anastomosis between donor SMA and recipient infrarenal aorta and cuffed end-to-end anastomosis between donor PV and left renal vein of recipient. The distal end of graft was exteriorized to form an enterostoma. RESULTS: Average time of an operation was 130 minutes and the mean warm ischemia time of grafts was 30 minutes. The technical success rate of this model was 100% and 7-day survival was 95.6% (86/90). CONCLUSION: This simplified technique was effective and practical to improve the outcome of rat heterotopic SBT.     

改进技术的大鼠全小肠移植术

目的建立并发症少、成活率高的大鼠异位全小肠移植模型。方法应用显微外科技术对１９６只Ｗｉｓｔａｒ大鼠施行异位全小肠移植。术前缩短禁食时间,补充能量,术中静脉输液;减少对供肠的机械和缺血性损伤;重建供肠血管采用腹主动脉－腹主动脉吻合以及门静脉－左肾静脉套管法吻合。结果热缺血时间≤４０±５分钟,吻合口无血栓形成及狭窄,９８只接受小肠移植大鼠的存活率为８８．７８％（８７／９８）。结论改进技术后的大鼠全小肠移植术具有并发症少,存活率高的特点,并且稳定、实用     

小鼠异位小肠移植模型的技术改进

目的 探讨小鼠异位小肠移植的技术要点并进行相应改进,为小肠移植的研究提供可靠的动物模型.方法 53只Balb/C小鼠的节段小肠异位移植于C57BI/6小鼠腹腔.适当缩短切取小肠及血管蒂门静脉的长度;应用缝针法建立受体腹主动脉前壁的椭圆形切口,穿刺法建立下腔静脉前壁切口;两点定位连续缝合法吻合血管;近端结扎封闭,远端与受...     

Microsurgical techniques in rat heterotopic small bowel transplantation: analysis of 450 cases

BACKGROUND: We sought to review 450 rat small bowel transplantation (SBT) operations having a modified microsurgical technique to discuss the key steps for a successful operation. METHODS: Four hundred fifty rat heterotopic small bowel transplantations were performed in 3 stages: the first 80 cases were a training stage, the following 330 cases were for formal experiments, and, in the last stage, 40 cases were to analyze the relationship between the duration of cold preservation and recipient mortality. For all cases, revascularization of the graft was accomplished by an end-to-side anastomosis between the donor superior mesenteric artery or aorta and the recipient infra-renal aorta, and cuffed end-to-end anastomosis between the donor portal vein and the left renal vein of the recipient. The duration of each operation, graft warm ischemia time, and recipient survival rate were compared. RESULTS: In the first stage, the graft warm ischemia time was about 90 minutes where as it was only 35 minutes in the second stage. The longterm survival rates (>5 days) of recipients were 8.8% and 97.3%, respectively. In the 3rd stage, long cold preservation period significantly increased recipient mortality. CONCLUSIONS: Graft warm ischemia time was a key issue associated with recipient mortality; a well-trained, simplified microsurgical anastomosis between graft superior mesenteric artery and recipient aorta accomplished in a shorter time rendered intravenous transfusion not essential for the recipient.     

简化的大鼠异位全小肠移植术

目的:建立简化的大鼠异位全小肠移植术技术,以提高手术成功率,为相关研究奠定基础.方法:供、受体均为雄性近交系Wistar大鼠,共180只,配对手术.采用供肠的肠系膜上动脉与受体肾下腹主动脉端侧吻合、门静脉与受体左肾静脉套管法端端吻合重建移植小肠血供,移植小肠远端腹壁造口.结果:手术耗时130min,移植小肠热缺血时间约30min.90只受全大鼠术扣即时存活率为100%,长期存活率(＞7d)为95.6%.结论:简化术式具有操作简便,移植小肠的热缺血时间短,手术成功率高等优点,有利于后续研究工作的开展.     

Combined pancreaticoduodenal-kidney transplantation in rats

The objective of this work was to establish a stable and simple simultaneous pancreaticoduodenal-kidney transplantation model in rats. The methods involved harvesting a pancreaticoduodenal-kidney (left) (PDK) and 1-cm inferior vena cava (IVC) with a 0.5-cm left and right iliac communis vein from donors and to "cuff" anastomose between portal vein and right iliac communis vein, left kidney vein, and left iliac communis vein, converging donor portal vein and left kidney vein into IVC together. Next, we performed an anastomosis of the donor arterial segment and recipient abdominal aorta and a "cuff" anastomosis between donor IVC and recipient left kidney vein. Of 67 transplanted rats in which diabetes was induced, 57 survived >7 days, 55 survived 1 month, 54 rats have survived >4 months. In 51 rats, nonfasting plasma glucose levels were euglycemic. We performed three "cuff" anastomoses to simplify the surgical procedure and to shorten the ischemia time of the graft; the recipient vein system has an integrated endovenous membrane to avoid venous thrombi in venous anastomosis sites.     

Rat model of orthotopic gastric transplantation

INTRODUCTION: We tried to find a better surgical procedure of reconstruction after total gastrectomy. Seventy rats were operated to establish a model of orthotopic gastric transplantations which may also be important for abdominal multivisceral transplantation. OBJECTIVE: To establish a rat model of orthotopic gastric transplantation. METHODS: In the donor operation; after the spleen was resected and the proper hepatic artery ligated, the stomach was infused with cold (0 degrees C to 4 degrees C) sodium lactate Ringer's solution via the aorta. The stomach was resected with its peripheral blood vessels-the celiac trunk, the left gastric artery, the splenic artery, the common hepatic artery, the gastroepiploic artery, and the portal vein. In the recipient operation; after the stomach and the spleen were resected, the donor stomach was implanted. An end-to-side anastomosis was performed for the portal veins. After the end-to-end anastomosis between the donor celiac trunk and the recipient left gastric artery, the blood flow was opened. Then the anastomoses of the duodenum, and donor cardia to the recipient esophagus were performed in end-to-end style. RESULTS: Thirty five operations were performed, in which the success rate in the last 20 cases was 80% (16/20). The average operative time was 2.35 hours. The longest survival time was over 3 months. CONCLUSION: A rat model of orthotopic gastric transplantation was successfully established and provides a method to study abdominal multivisceral transplantation. It also provides a new way for reconstruction after the total gastrectomy.     

Simultaneous pancreaticoduodenal-kidney transplantation in rats.

AIMS: To establish a stable and simple simultaneous pancreaticoduodenal-kidney transplantation model in rats. METHODS: Pancreaticoduodenal-kidney (left) and 1 cm of the inferior vena cava (IVC) with 0.5 cm left and right iliac communis vein were harvested from donors. We performed 'cuff' anastomoses between (1) portal vein and right iliac communis vein and (2) left kidney vein and left iliac communis vein, converging donor portal vein and left kidney vein into IVC together. Next, we performed an anastomosis of donor arterial segment and recipient abdominal aorta and a 'cuff' anastomosis between donor IVC and recipient left kidney vein. RESULTS: Of 40 transplanted rats in which diabetes was induced, 33 survived over 7 days, and 31 rats have survived over 4 months. 30 rats' nonfasting plasma glucose levels were euglycemic. CONCLUSIONS: We performed three 'cuff' anastomoses to simplify the surgical procedure and to shorten the ischemic period of the graft. The recipient vein system has an integrated membrane to avoid thrombi in venous anastomosis sites, enhancing the transplantation success rate.     

小鼠肝移植中两种肝动脉重建方法的比较

目的比较小鼠肝移植中两种不同肝动脉重建方法的效果。方法应用雄性C57BL/6小鼠建立小鼠肝脏移植模型,随机分为肠系膜上动脉重建组（14对）和腹主动脉重建组（16对）。手术采用异氟醚吸入麻醉。供肝经门静脉灌注4℃威斯康星大学保存液（UW液）。两组小鼠的肝动脉重建分别采用供体肠系膜上动脉或供体肾下腹主动脉与受体腹主动脉端侧吻合两种方法。移植肝血流恢复后重建肝动脉。胆管采用内支架管的方法重建。观察术后2周移植物的存活情况和肝动脉通畅与否。用组织病理学方法检查移植肝的组织形态变化,用免疫组织化学法观察肝脏再生功能。结果术中无小鼠死亡,手术成功率为100%。肠系膜上动脉重建组供体肝动脉游离时间为（12.1±2.5）min,腹主动脉重建组为（17.3±3.1）min,比较差异有统计学意义（P〈0.05）。腹主动脉重建组肝动脉吻合时间为（14.5±2.9）min,肠系膜上动脉重建组相应为（12.4±3.3）min,比较差异无统计学意义（P〉0.05）。肠系膜上动脉重建组移植物术后2周存活率为93%（1只死于吻合口血栓形成）,腹主动脉重建组为100%。肠系膜上动脉重建组术后2周肝动脉通畅率为86%,腹主动脉重建组为100%。组织病理学检查示两组的移植肝组织正常,肝脏再生反应不明显。结论小鼠肝移植中,与应用肠系膜上动脉重建比较,应用腹主动脉吻合重建肝动脉的效果更好且安全,建议首选供受体腹主动脉吻合重建小鼠肝动脉的方法。