非转流小型猪原位肝移植模型的建立及评价

目的建立标准化程度高、重复性和稳定性好的小型猪原位肝移植模型。方法选巴马小型猪为实验动物,在非体外静脉转流条件下行同种异体原位肝移植术,观察动物存活率及术中血流动力学、血气和生化指标的改变。结果在非体外静脉转流条件下行同种异体原位肝移植20例,平均手术时间为(181±25.8)min,平均无肝期(28.4±3.2)min。在无肝期,血流动力学和代谢发生急剧变化:平均动脉压(MAP)从无肝前期的(14.59±1.68)kPa(1cm H2O=0.098kPa)降至(5.87±0.91)kPa,中心静脉压(CVP)从(0.66±0.11)kPa降至(0.27±0.10)kPa;体温、pH、剩余碱(BE)及HCO3ˉ显著降低,心率及血清K+显著升高(P<0.05);随着门静脉和下腔静脉血流的开放,血流动力学及代谢紊乱即逐渐恢复正常。动物1周存活率为90%,16头动物存活2周以上。肝功结果:术后第1天ALT、AST和TBIL显著升高并达到峰值,第2天开始下降,第7天降至麻醉后水平。结论非转流条件下的小型猪同种异体原位肝移植模型具有标准化程度及手术成功率高、重复性和稳定性好的优点,是大型动物肝移植系列研究的理想动物模型。     

巴马小型猪后肢外侧隐静脉后支抽血方法的研究

目的:探讨小型猪后肢外侧隐静脉后支抽血的方法.方法:采用一次性使用静脉输液针穿刺巴马小型猪后肢外侧隐静脉后支,用注射器抽取所需要的血量.结果:操作顺利,能够采集所需血量,抽血成功率95.83％(46/48),未出现抽血部位皮肤感染和血样污染.最后一次抽血后第6天处死动物并解剖,发现抽血部位的皮下组织未出现感染,穿刺部位的血管未见到闭塞.结论:在小型猪后肢外侧隐静脉后支抽血,具有方法简单、损伤小、效果可靠、不需要麻醉的特点.     

巴马小型猪脑死亡状态下的肺脏形态变化及其机制

目的 探讨脑死亡状态下肺脏形态变化及可能的机制。方法 巴马小型猪10只，随机分为2组，即脑死亡组与对照组。应用改进的缓慢间断颅内加压法建立脑死亡模型，通过呼吸、循环支持维持实验动物脑死亡状态24h，对照组仅行开颅。分别测定脑死亡后第3、6、12、18和24h时血清中肿瘤坏死因子（TNF—α）、白细胞介素1（IL-1β）及IL-6水平；脑死亡后24h时取肺脏组织，HE染色观察肺脏组织变化，电镜观察肺脏超微结构变化，免疫组化染色观察蛋白激酶C（PKC—α）的表达水平，逆转录聚合酶链反应检测PKC—amRNA的表达水平。结果 对照组各检测时点的IL-1β、IL-6、TNF-α水平变化不明显，脑死亡组血清IL-1β、IL-6、TNF—α明显高于对照组（P〈0．05），并随脑死亡时间的延长而逐渐升高（P〈0．05）。肺组织中PKC-α蛋白及其mRNA水平明显高于对照组（P〈0．05）。对照组的肺组织在光镜及电镜下未见明显的损伤性变化，脑死亡组动物的组织结构发生明显改变，光镜下可见肺泡间隔增宽，肺泡腔有渗出液，肺毛细血管充血，肺组织中有淋巴细胞浸润；电镜下，脑死亡组的肺泡细胞胞质水肿，肺泡上皮Ⅱ型细胞线粒体肿胀，线粒体部分膜溶解等改变，微绒毛缺失。结论 脑死亡状态导致肺脏出现损伤性形态学变化，机体炎症介质水平升高；肺脏中PKC—α mRNA转录和蛋白翻译水平明显升高可能是肺脏发生损伤性形态学变化的原因之一。     

次全结扎冠状动脉法构建巴马小型猪心肌缺血模型

目的采用次全结扎巴马猪冠状动脉法建立心肌缺血模型。方法对10只巴马小型猪术前行冠状动脉CTA(CCTA)及心脏MR(CMR)检查。开胸后次全结扎冠状动脉左前降支建立模型,并于术后2、12、24、48、72h及1、2、3、4周复查CTCA及CMR,测心功能指标,包括左心室舒张末期容积(LVEDV)、收缩末期容积(LVESV)及射血分数(LVEF)。术后4周处死实验动物行病理检查。结果7只巴马小型猪顺利完成手术,建模成功率70.00%。建模后CTCA示结扎处狭窄程度约80%～100%;与术前比较,术后24h后不同时间点LVEF下降(P0.05)、LVESV增加(P0.05),术后2周后不同时间点LVEDV增加(P0.05)。CMR检测梗死节段与病理结果的一致性较好(Kappa=0.888)。结论次全结扎冠状动脉左前降支可建立良好的心肌缺血动物模型。     

肝脏解剖和肝脏手术切除术统一名称

随着肝脏外科手术技术的不断改进和创新 ,对肝脏解剖的认识必然更加深化且有所更新 ,同时也出现了一些新的解剖和手术命名 ,再加上和国外交流的增多 ,有些名称需要和国际一致或接轨。有鉴于此 ,香港中文大学刘允怡教授 ,以 2 0 0 0年 5月在澳大利亚的布里斯班世界肝胆胰大会宣布的“2 0 0 0年布里斯班肝脏解剖和切除手术的命名”为蓝本 ,结合我国的实际情况 ,经过国内部分肝脏外科专家的研究和讨论 ,翻译了这一组新的命名 ,即“肝脏解剖和切除手术统一名称”。今在本刊发表 ,供外科同道借鉴和参考 ,并希望提出意见 ,以期不断完善。     

幼猪辅助性部分肝移植供肝体外解剖学观察及其修整分割

目的体外观察幼猪供肝的解剖学特点,总结辅助性部分肝移植供肝修整分割经验。方法16头幼猪供肝灌洗取出后于体外进行解剖学观察,借用探针条探查肝动脉和胆管,用刮扒水洗法切除左半肝,断面管道仔细结扎,余下右半肝作为供肝。结果幼猪肝脏质地脆嫩,分为左外侧叶、左中叶、右中叶、右外侧叶和尾状叶等5叶。其各部分体积、质量与其体质量呈正相关。肝中裂较浅,但其间少有门静脉交通支存在。肝固有动脉可有变异。肝静脉均于肝内汇入下腔静脉,左半肝回流静脉多有共干（14/16）。肝上、肝下下腔静脉均短,肝内下腔静脉下段肝实质较薄。16例供肝修整分割均顺利完成,断面管道显露清晰,复流后充盈良好,肝断面出血少。结论根据幼猪体重可估计其肝脏各部体积和质量;刮扒水洗法行供肝体外分割简便实用;获得的右半肝作为供肝,其肝上下腔静脉易于与受体肝内下腔静脉端侧吻合。     

肝脏右后下静脉的临床解剖学研究

目的 观测肝脏右后下静脉(inferior right hepatic veins,IRHV)的解剖学结构.方法 60具成人尸体肝脏标本,根据肝右后静脉汇入下腔静脉肝后段上、中、下1/3的部位分为上、中、下三组.观察测量IRHV的出现率、数目、口径、肝外行程及其与肝右静脉的关系.结果 IRHV出现率为83.33%,口径为2.62～18.46(14.32±1.21)mm,肝外长度为3.26～47.65(10.78±7.81)mm.IRHV直径与其数量呈负相关.IRHV直径与肝右静脉直径呈负相关,IRHV数量与肝右静脉直径呈正相关.结论 IRHV口径粗大,出现率高,有肝外行程,和肝右静脉呈彼消此长关系.在肝切除术中应注意避免损伤,活体肝移植时应施行IRHV的修复重建.

Abstract：

Objective To observe the anatomy of the inferior right hepatic veins (IRHV).Methods The IRHVs were divided into 3 groups according to the location where they entered into the retrohepatic inferior vena cava at: the upper 1/3, middle or lower 1/3. The incidence, number, caliber, extrahepatic length and the relationship between the major hepatic veins (the right, middle and the left hepatic veins) and the IRHV were observed and measured in 60 adult cadavers. Results The incidence of IRHV was 83.33% with an average diameter of 2.62-18.46(14.32±1.21)mm. Its extrahepatic length was 3.26-47.65 (10.78±7.81)mm. There was a marked negative correlation between the diameter of the IRHV and its number, a marked negative correlation between the diameter of the IRHV and the diameter of the right hepatic vein and a marked positive correlation between the number of the IRHV and the diameter of the right hepatic vein. Conclusions There were high variations in the incidence and anatomy of the IRHV which were related to the diameter of the right hepatic vein. The IRHV was not to be torn during liver resection and should be reconstructed in right liver grafts.     

小型猪原位肝移植模型的建立与评价

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。     

肝尾状叶手术的应用解剖研究

目的：为肝尾状叶手术提供形态学理论基础。方法：选取42具成人离体尸肝标本，采用雕琢法观测肝尾状叶形态、毗邻及管道。制作6具肝静脉铸型标本，观测尾状叶静脉系统属支及走行。制作1具肝尾状叶生物塑化薄层连续断面标本，并行计算机三维重建，显示尾状叶空间关系。利用3具整尸行单独全尾状叶切除。结果：大体解剖发现尾状叶门脉三管来源分散，行程短，不集中；铸型标本发现尾状叶门静脉有集中分布的优势；成功重建尾状叶及毗邻主要管道空间关系；在整尸上，顺利完成单独全尾状叶切除。结论：肝尾状叶位置特殊，毗邻关系复杂。肝尾状叶切除手术方式应依据病变部位及大小、性质、肝功状况而定，经后下入路游离尾状叶是值得尝试的途径。     

Kidney allotransplantation in miniature pigs

Summary Kidney allotransplantation was performed in 15 fully grown miniature pigs, mainly females, and 2 female piglets. In fully grown animals the donor organ was transplanted in the iliac fossa. A different technique was employed in young dwarf pigs; the donor kidney was removed en bloc with a segment of the abdominal aorta and vena cava and was transplanted isotopically in the recipient. Blood group incompatibility is discussed as a cause of failure of pig kidney allotransplants from non-related animals. Between sister animals with similar blood groups kidney transplants could be performed successfully, but transplants between sisters of proven different blood groups did not function. In dwarf pigs hyperacute early rejection must be distinguished from late rejection. Hyperacute early rejection which occurs only a few hours after transplantation in cases of blood group incompatibility between donor and recipient, is due to immunological damage to vascular endothelium, leading to widespread arterial thromboses. Later rejection between sister animals of identical blood group occurs between the 14th and 40th day after transplantation. It is characterised by a large, oedematous kidney with petechial haemorrhages in the parenchyma and microscopically demonstrable changes in the arterial tree.Supported by the Land Nordrhein-Westfalen     

肩关节应用解剖与假体设计

自1953年Neer首先将其研发的钻铬合金肩关节似体用于治疗肱骨头粉碎性骨折并取得较好疗效以来,人工肩关节置换术已经成为一种成熟的手术被广泛推广。肩关节应用解剖研究不仅是推动手术改进的基础,更重要的是肩关青假体设计的基础。随着肩关节应用解剖研究的进展,人工肩关节假体已从第一代限制型假体发展到了第三代解剖型假体,从而取得了更好的疗效。     

额眉部除皱术的应用解剖学研究

目的:为额眉部除皱术提供解剖学基础。方法:在100个成人颅骨和30具成人尸体标本上解剖和观测了额眉部与除皱术有关的组织结构。结果:眶上和滑车上切迹(孔)至正中线的距离分别为22.8mm±5.3mm和16.5mm±2.8mm,至眶上缘的距离分别为3.5mm±1.4mm和3.2mm±1.5mm。额眉部薄的皮下组织与皮肤和深面的肌组织连接紧密,肌组织与深面的额骨外膜以疏松组织相连,其内走行有眶上、滑车上、颞浅和面血管神经支。眶上动脉神经从眶上缘内、中1/3交界处几近垂直上行,其入肌点是眶上缘上方1.4cm±0.3cm;滑车上动脉神经行于内眦与额正中线之际上1cm点连线的深面,分支入肌点在该线的上2/3部;颞浅动脉额支从鬓角穿出行向额肌,入肌点是外眦上方4.5cm±0.8cm。面神经颞支行于额支动脉的下方,在额肌与眼轮匝肌交角处先交织成网,由网再分支入肌。结论:额眉部除皱术宜于额肌下分离,避免损伤相关的血管神经。     

Effect of chymase activity on skin thickness in the Clawn miniature pig hypertrophic scarring model

Objective: The female red Duroc pig, a heavy and cumbersome animal, is routinely used as an animal model for hypertrophic scarring. Chymase, a chymotrypsin-like serine protease, plays an important role in skin fibrosis. This study aimed to create a lightweight pig hypertrophic scarring model using Clawn miniature pigs, and to investigate the role of chymase in hypertrophic scarring.

Methods: After creating four skin wounds (7.5?×?7.5?cm, depth?=?0.15?cm) in each pig, skin biopsies were performed after 15, 30, 60, 90, 120, and 150?days. Skin thickness, water content, hydroxyproline percentage, chymase activity, and transforming growth factor-beta 1 concentration were measured, and pathological analyses were performed.

Results and conclusions: Both tissue thickness and chymase activity were increased in scar tissue, peaked on day 90 after injury, and then gradually decreased. Peripheral scar tissue showed higher chymase activity than central scar tissue. Neither chymase activity nor transforming growth factor-beta 1 was detected in the surrounding normal skin, whereas central scar tissue showed a high transforming growth factor-beta 1 concentration, peaking on day 15, and decreasing to normal by day 120. We found the Clawn miniature pig to be a useful model for hypertrophic scarring. Chymase activity and skin thickness were well-correlated, suggesting that scars thicken when chymase activity is high.     

Early biological and immune response to semi-identical liver or kidney allograft in miniature swine

In inbred miniature swine, semi-identical liver allograft recipients survive up to 3 months without immunosuppression, whereas similarly mismatched kidney allografts are uniformly rejected within 2 weeks. The early biological and immunological events were assessed in this unique model. SLA(d/d) pigs (MGH, Harvard Medical School, Boston, MA, USA) received liver or kidney allograft from heterozygous SLA(c/d) miniature swine. Survival, graft function, histology, intragraft cytokines, peripheral lymphocyte and platelet count, plasma cortisol level and cellular/humoral anti-donor immune response were assessed. Kidney allografts were uniformly rejected within 2 weeks, whereas liver allografts survived for up to 87 days. After both liver and kidney transplantation, the peripheral lymphocyte count decreased during the first week concomitantly to a significant elevation of plasma cortisol level. Early decrease of peripheral platelet count was observed after liver but not renal transplantation. Up-regulation of transforming growth factor beta1 (TGF-beta1) and interferon-gamma (IFN-gamma) was observed during the first postoperative week in semi-identical liver allografts and IFN-gamma as well as IL-10 in kidney allografts. In liver recipients, labelled autologous lymphocytes accumulated in the liver graft and native spleen, whereas after renal allograft, lymphocytes accumulated in the native spleen and liver but never in the kidney allograft. Specific cellular anti-donor unresponsiveness was observed from the first post-transplant day in both liver and kidney recipients, while the humoral anti-donor response remained intact. In semi-identical liver allograft, recipient rejection is milder and slower than in similarly matched kidney allograft. The intragraft up-regulation of TGF-beta1 in semi-identical liver allograft might be one mediator to explain the modulation of rejection after liver transplant. The rapid, nonspecific accumulation of recipient lymphocytes in the liver allograft but not in kidney allograft might also play a role in the different survival time in this model.     

男性盆腔神经丛及神经血管束的应用解剖

目的认识盆丛、神经血管束（NVB）与周围组织器官的关系。方法对10例成人男性盆腔器官标本作盆丛、NVB大体解剖,1例43岁成人新鲜盆腔脏器作连续切片,观察盆丛、NVB与周围组织器官的关系。结果盆丛位于腹膜后、直肠的侧壁,呈网络状,精囊腺的后外侧,由盆丛发出的阴茎海绵体神经在前列腺后外侧走行,这些神经与前列腺被膜血管组成NVB。NVB的密度沿前列腺下行时逐渐变稀,在膜部尿道的外侧和后外侧分布于尿道旁的横纹肌中。结论明确盆丛、NVB位置以及与盆腔器官的毗邻关系,有助于术中有效鉴别和保护盆丛和NVB,达到保留性神经的盆腔、会阴部手术的目的。