猪急性缺血性肝衰模型的建立和辅助性异位部分肝移植的作用

目的: 探讨急性缺血性肝衰模型的制备、辅助性异位部分肝移植的作用. 方法: 用家猪配对开展辅助性异位部分肝移植.分三组,A组:受体肝脏和肝动脉保持原状,其门静脉缩窄;供肝植入受体右肝下,仅建立门静脉血供,不建立动脉血供.B组:受体肝动脉结扎,其他手术内容与A组相同.C组:受体肝动脉结扎,供肝动脉和门静脉血供均建立,其他手术内容与A组相同.监测各组受体存活情况,肝功能和肝脏血流情况,病理及供肝胆汁分泌情况. 结果: A组、C组受体3 d以上成活率显著高于B组.A组、C组手术前后胆红素无显著改变,B组术后胆红素显著高于术前,术后第二天B组胆红素显著高于A组、C组.C组供肝胆汁分泌和血供良好,肝细胞存活并有活跃的代偿性增生;A组、B组供肝无或仅有少量胆汁分泌,肝细胞大片坏死. 结论: 受体肝动脉结扎、门静脉缩窄足以造成急性肝衰模型;保留受体肝脏动脉血供、减少门静脉血供对受体肝脏功能无严重影响;辅助性异位部分肝移植能取得良好的效果,足以纠正急性肝衰.

Preparation of acute ischemic liver failure and the effect of auxiliary heterotopic partial liver transplantation in pigs

Objective:To investigate preparation of acute ischemic liver failure,and the effect of auxiliary heterotopic partial liver transplantation.Methods:Auxiliary heterotopic partial liver transplantation was performed in pigs. Three groups were used. Group A:host's liver and liver artery was kept untouched while portal vein was shrinked;donor liver was transplanted under the host's right liver,and only portal vein supply is constructed,with arterial blood supply remained unconstructed. Group B:host's liver artery was ligated,other operation procedures being the same with group A. Group C:host's liver artery was ligated,both portal vein supply and arterial blood supply were constructed,other operation procedures being the same with group A. The living condition,liver function,blood supply,pathology and bile secretion of graft liver were observed.Results:The surviving rates are significantly higher in group A and group C than that in group B,the concentrations of bilirubin aren't significantly different between group A and group C post operarion and pre operation,but it is significantly higher in group B in post operation,the concentrations of bilirubin in group B are significantly higher than those in group A and group C on the second day after operation. In group C,the graft liver' bile secretion and blood supply are good and hepatocyte of graft liver lives and proliferates well. In group A and B,the graft liver doesn't secret bile and hepatocyte is necrotic.Conclusion:The ligated host's liver artery and shrinked portal vein can result in acute ischemic liver failure. Auxiliary heterotopic partial liver transplantation is effective to treat liver failure. Reduced portal vein boold supply isn't much harmful to liver.