大鼠腹部心脏移植模型的改进

目的:建立一种操作简单、成功率高的大鼠异位心脏移植模型。方法:以雄性SD大鼠为供体,Wistar大鼠为受体,切除受体鼠左肾,使供心升主动脉与受体腹主动脉端侧吻合,供心右肺动脉套接于受体左肾静脉。结果:50例实验成功46例,成功率92％,供心平均缺血时间为(38.9±1.8)min。失败原因:吻合口出血2只,血栓形成和套管扭转各1只。结论:该改良术式是建立大鼠心脏移植模型简单实用的方法之一。     

套管改良法建立大鼠颈部心脏移植模型

目的:采用套管改良技术建立大鼠颈部心脏移植模型和研究心脏移植再灌注损伤。方法:采用同系移植,供受体均为SD大鼠。用0.7mm内径聚乙烯管做内置管,将供心的无名动脉与受体右颈总动脉连接;用1.5mm内径聚乙烯管做内置管,将供心的肺动脉与受体右颈外静脉连接。结果:正式实验30次,手术成功率97%。手术时间和供心热缺血时间显著缩短,手术成功率明显提高。结论:套管改良法简单实用,无须血管吻合技术,为器官移植研究提供了更为方便、快捷的方法,值得推广。     

改进套管法建立大鼠颈部心脏移植模型

目的改进套管连接血管技术制作大鼠颈部异位心脏移植模型,建立更合理、符合实验需要的心脏移植模型。方法心脏移植供体为雄性Wistar大鼠80只,清洁级,体重250-300g;受体为雄性F344大鼠80只,清洁级,体重300-350g。用自制套管将供心肺动脉套接于受体右颈外静脉,将供心升主动脉套接于受体右颈总动脉。结果正式实验80次,移植成功77次,成功率96％。总手术时间50-70min,吻合时间2-4min,供心冷缺血时间10-15min。结论改进套管法建立大鼠颈部同种异体心脏移植模型无需显微外科操作,是一种经济实用、操作简单、稳定可靠、易于复制的动物模型,便于推广。     

复制大鼠异位心脏移植模型100例的体会

目的 :总结复制大鼠腹腔异位心脏移植模型的体会。方法 :健康远交系Wistar大鼠为供体 ,SD大鼠为受体 ,各 10 0只。供心的升主动脉及主肺动脉分别与受体的腹主动脉和下腔静脉做端侧吻合 ,将供心移植于受体的腹腔内。结果 :共建立 10 0例大鼠异位心脏移植模型 ,供心缺血时间 (30± 5 )min ,手术成功率 91%。结论 :手术成功的关键 :1.麻醉剂量合适 ;2 .注意供心的保护 ,缩短供心缺血时间 ;3.提高血管吻合质量 ,避免吻合口出血及血流不通畅 ;4 .术后保温 ,纠正酸中毒     

二步法大鼠原位全小肠移植模型的建立与改进

目的:建立一种简单稳定、死亡率低的二步法大鼠原位小肠移植模型.方法:整块获取带肠系膜上动脉的腹主动脉和门静脉的全小肠,血管重建采用供体腹主动脉和受体腹主动脉端侧吻合、供体门静脉和受体左肾静脉端套管吻合.受体第一步手术时,供肠远端端侧吻合于受体的末端回肠,已结扎的供肠近端固定于右侧腹壁(不做腹壁造口).7d后行第2步手术,自Tritze韧带下1cm到回肠吻合口上1cm切除受体小肠,受体空肠残端端侧吻合于供肠近端.结果:共进行二步法大鼠原位小肠移植手术174次,正式实验44次,手术成功率90.9%.受体第1次手术时间约50±15 min,其中动脉吻合时间约为20±5 min,静脉吻合时间2±1 min,受体第2次手术时间约35±15 min.4只大鼠死于第一次手术后5 d内,2只死于肠瘘,1只死于麻醉意外,1只死于肠梗阻.第2次术后没有大鼠死亡,40只大鼠均长期存活(超过3 mo).结论:二步法大鼠原位小肠移植方法安全可靠,并发症少,生存率高.     

大鼠颈部异位心脏移植模型的改进

为了降低大鼠颈部心脏移植技术难度及提高存活率，将Chen式术式加以改进，采用供心左肺动脉与受体右颈外静脉端端吻合。结果表明新术式降低了手术难度，7天存活率为93．3％。认为新术式简单、实用，值得推广。     

简化的大鼠心脏异位移植术

简化和改进大鼠异位心脏移植模型。不需要显微放大设备,先准备受体,将供心升主动脉和主肺动脉分别端侧吻合于受体的腹主动脉和下腔静脉上。手术成功率达８５ ％ 以上。这种方法简便易行,成功率高     

大鼠小肠移植的外科技术

目的总结大鼠异位全小肠移植的外科手术．方法整块切取的供肠的范围包括全小肠、门静脉及带肠系膜上动脉的腹主动脉段端，在术中进行供肠原位灌注和肠腔灌洗．动脉吻合采用供体的带肠系膜上动脉的腹主动脉段端侧吻合于受体的腹主动脉，静脉吻合利用Ｃｕｆ套管技术将供体的门静脉与受体的左肾静脉端端吻合．移植肠两端腹壁双造口．供、受体术中均补液６ｍＬ～８ｍＬ．结果共进行１８９次移植手术，其中正式实验３３次，手术成功率为８４８％．供体手术时间８０ｍｉｎ±１０ｍｉｎ；供肠修理时间１０ｍｉｎ±３ｍｉｎ；受体手术时间９５ｍｉｎ±１５ｍｉｎ，其中动脉吻合时间１８ｍｉｎ±５ｍｉｎ，静脉吻合时间１ｍｉｎ；移植肠温缺血时间２２ｍｉｎ±５ｍｉｎ，冷缺血时间控制在６０ｍｉｎ以内．整个手术过程为一人操作，手术时间约３ｈ．结论移植肠的获取、血管吻合技术、术中血容量的维持是外科技术的关键，移植肠术中的处理及保温、感染问题也应重视     

门静脉回流技术在胰肾联合移植动物实验中的应用

目的研究门静脉回流技术在胰肾联合移植动物实验中的应用。方法 24只杂交长白猪随机分为体循环回流组(SVD)和门静脉回流组(PVD),每组内随机分为供、受体,经供体猪腹主动脉原位灌注,大块联合切取供体胰、节段十二指肠、左肾、脾脏。修剪移植肾脏、胰腺和十二指肠,左肾静脉与肠系膜上静脉吻合后．PVD组采用移植物门静脉与受体肠系膜上静脉吻合,SVD组采用移植物门静脉与下腔静脉吻合。各组腹主动脉与受体腹主动脉吻合,十二指肠内置人T型管、输尿管内置人脑室引流管自腹壁引出待Ⅱ期手术吻合。结果 SVD组和PVD组手术均很成功,供肾、胰植入受体后立即恢复良好的血液循环,并且迅速恢复功能,平均存活期分别为12d和14d。结论门静脉回流技术是可行的。     

大鼠原位肝移植肝上腔静脉不同吻合方式的比较

目的探讨肝上腔静脉不同吻合方式对大鼠原位肝移植的影响．方法以ＳＤ大鼠为供受体，行原位肝移植８０例，其中肝上腔静脉吻合采用套管法２０例，改良缝合法６０例．结果套管法吻合肝上腔静脉平均为８６ｍｉｎ，受体手术时间２８８ｍｉｎ，无肝期１２１ｍｉｎ，手术成功率９００％；改良缝合法吻合肝上腔静脉平均为１０ｍｉｎ，受体手术时间３２５ｍｉｎ，无肝期１３６ｍｉｎ，手术成功率９３３％，两者无显著性差异（Ｐ＞００５）．套管法移植术后１周存活率为１００％，而改良缝合法为８８３％，两者相差显著（Ｐ＜００１）．结论改良缝合法与套管法相比，手术时间和成功率相近，而移植术后１周存活率明显高于套管法．     

80例大鼠异位心脏移植的体会

为研究心脏移植后急性排异反应及心脏缺血再灌注损伤 ,我们建立了大鼠异位心脏移植模型。Wistar大鼠心脏的升主动脉及主肺动脉分别与SD大鼠的腹主动脉和后腔静脉做端侧吻合 ,将Wistar大鼠心脏移植于SD大鼠腹腔内。 80例大鼠异位心脏移植模型成功建立 ,手术成功率 90 0 %。我们从以下方面作了总结 :1 麻醉 ;2 供心的摘取及保存 ;3 受体的准备 ;4 心脏移植 ;5 术后处理     

小鼠异位心脏移植模型的建立

目的 采用小鼠清洁级近交系Balb/c和C57BL/6雄性小鼠进行同种、同基因和同种异基因间心脏移植.方法 在受体小鼠建立颈部的异位心脏移植模型,手术将供体小鼠心脏的升主动脉和肺动脉分别与受体小鼠颈总动脉和颈外静脉进行端端吻合,移植后的心脏位于小鼠颈部.血流途径为:受体颈总动脉、供心主动脉、供心冠状动脉、供心冠状静脉、供心右心房、供心右心室、供心肺动脉、受体颈外静脉.供心处于无负荷搏动状态.结果 成功建立37对小鼠颈部心脏移植模型,手术成功率(37/45,82%).总手术时间为(64±9) min,供心缺血时间为(31±10) min.同种、同基因和同种异基因间心脏移植存活时间分别为:90 d以上,90 d以上和(6.8±1.2)d.结论 小鼠颈部心脏移植模型简单、经济、稳定性强、重复性好,是进行心脏移植免疫学研究的较理想模型;Balb/c和C57BL/6小鼠品系纯正,是进行心脏移植免疫学研究的理想组合.     

Living related heterotopic auxiliary partial liver transplantation for extremely small-for-size graft in fulminant liver failure

Adult living related liver transplantation seeks a balance between donor safety and the need to save the recipient's life. A small-for-size graft is a major obstacle for high-risk patients. We experienced a case of heterotopic auxiliary partial liver transplantation with extremely small-for-size graft for fulminant liver failure. The other reasons why we chose to perform heterotopic auxiliary partial liver transplantation were acute renal failure, subshock state, and a left lobe volume of 24% in the standard liver volume of the donor. Hepatic vein reconstruction was made using an inferior meserteric vein patch graft. Portal vein reconstruction was made using end-to-side anastomosis employing an interposed left external iliac vein. The left hepatic artery of the graft was connected to the distal gastroduodenal artery. The patient was discharged 3 months after transplantation. We would recommend heterotopic auxiliary partial liver transplantation as an optional procedure for patients with severe preoperative conditions or extremely small-for-size graft donors.     

Two donor hearts beat in one chest

We present the case of a 52-year-old man who had end-stage dilated cardiomyopathy (left ventricular ejection fraction, 0.14) and type-A blood. He underwent orthotopic transplantation with a heart from a blood-type-A male donor on 18 January 2001. After transplantation, the patient could not be weaned from cardiopulmonary bypass. Due to calcification of the left main and right coronary arteries, we performed triple coronary artery bypass (left anterior descending, circumflex, and right coronary arteries) with the recipient's saphenous vein. Despite high doses of inotropic agents and intra-aortic balloon pumping, the patient could not be weaned from cardiopulmonary bypass; he was put on extracorporeal membrane oxygenation 2 hours later. Meanwhile, there was another donor (a woman with type-O blood), who weighed 48 kg. Upon harvesting that heart for a recipient who weighed 68 kg, we found a laceration of the right ventricle. Therefore, we decided to use this marginal donor heart to rescue the graft-failure transplant by means of heterotopic heart transplantation. We left the 1st donor heart in situ. The postoperative series of endomyocardial biopsies showed variations between the 2 donor hearts in degrees of mild-to-moderate rejection. During the 6-year, 2-month follow-up period, the patient has fared well with 2 donor hearts, which beat independently but in conjunction. We conclude that heterotopic transplantation of a marginal donor heart can save an otherwise-dying orthotopic transplant recipient.     

大鼠腹腔内心脏移植模型的建立

目的:改进大鼠腹腔内心脏移植模型。方法:对Ono术式腹腔内心脏移植模型制作进行改进,其法为经升主 动脉用0～4℃乳酸钠林格氏液灌注心脏,供心的升主动脉和肺总动脉分别与受体的腹主动脉及下腔静脉行端侧吻 合。结果:共建立大鼠腹腔内心脏移植模型40例,供心总缺血时间(37±2)min,手术成功率90％,供心跳动时间 平均为10天。结论:模型制作成功的主要因素:(1)供心的低温保护及缺血时间的控制;(2)良好的血管吻合,避 免吻合口漏血及血流不畅;(3)适当的麻醉。     

大鼠腹腔内心脏移植模型的建立

目的改进方法,建立大鼠腹腔内心脏移植模型。方法在Ono术式的基础上进行改进,经升主动脉用0℃～4℃乳酸钠林格氏液灌注心脏,供心的升主动脉和肺总动脉分别与受体的腹主动脉及下腔静脉行端侧吻合。结果共建立大鼠腹腔内心脏移植模型40例,供心总缺血时间(37±2)min,手术成功率90%,供心跳动时间平均为10d。结论模型建立成功的主要因素:①供心的低温保护及缺血时间的控制;②良好的血管吻合,避免吻合口漏血及血流不畅;③适当的麻醉。     

Increased sensitivity of the denervated transplanted human heart to isoprenaline both before and after beta-adrenergic blockade

It is not known whether surgical denervation leads to increased beta-receptor sensitivity after human cardiac transplantation. We assessed cardiac beta-receptor sensitivity by studying the heart rate response to isoprenaline of the denervated donor heart as compared with the innervated recipient heart in eight patients who underwent heterotopic cardiac transplantation and in six patients with orthotopic transplantation. Changes in the donor and recipient hearts seen in these 14 patients were further compared with those seen in 10 normal volunteers. Incremental intravenous infusion of isoprenaline (5, 10, and 15 ng/kg/min) raised heart rate to a greater extent in the donor compared with the recipient hearts in the eight patients who had heterotopic grafts (slopes [beats/min/ng/kg]: donor = +2.26, recipient = +1.59; p less than .01). In addition, the donor hearts of the transplant patients were more sensitive than hearts of the normal volunteers (slopes: donor = +2.26, normal = +0.94; p less than .01). The changes in the two groups of donor hearts were similar (slopes: orthotopic = +2.24, heterotopic = +2.27; NS). The recipient hearts in the patients with heterotopic transplants were more sensitive than the hearts of the normal volunteers (p less than .05), suggesting that the observed differences in isoprenaline sensitivity in the patients with heterotopic grafts were not caused by a decreased sensitivity of the recipient heart. After beta-blockade, the heart rate responses to isoprenaline were attenuated to the same extent in denervated and innervated hearts.(ABSTRACT TRUNCATED AT 250 WORDS)     

Improved technique of vascular anastomosis for small intestinal transplantation in rats

AIM To establish a new improved vascular anastomotic technique to simplify the surgical technique and increase the survivsl rate of small intestinal transplantation in rats. METHODS The graft removed en bloc consisted of entire small intestine, portal vein and aortic segment with superior mesenteric artery. The graft was perfused in situ and the gut lumen was irrigated during the operation.Heterotopic small bowel transplantation was performed by microvascular end-to-side anastomosis between the donor aortic segment with superior mesenteric artery and the recipient abdominal aorta, and by the formation of a "Cuff" anastomosis between the donor portal vein and the recipient left renal vein. Both ends of the grafts were exteriorized as stomas. RESULTS A total of 189 intestinal transplantations were performed in rats, 33 of which were involved in the formal experimental group, with a survival rate of 84.8%. The average time for the donor surgery was 80min ±10min; for graft repair 10min ± 3min; and for recipient surgery 95min ± 15min. The average time for the arterial anastomosis and the vein anastomosis was 18min ± 5min and imin,respectively. The warm ischemic time and cold ischemic time were 22min ± 5min and less than 60min, respectively. The whole operation was completed by a single surgeon, the operative time being about 3 hours. CONCLUSION The vascular anastomosis used in this study could simplify surgical technique,reduce the operative time and elevate the survival rate of small intestinal transplantation in rats.     

Modified techniques of heterotopic total small intestinal transplantation in rats

AIM：To establish a successful model of heterotopic total small inestinal transplantation(SIT)in rats in order to reduce the complications and increase the survival rats.METHODS:A total of 196Wistar rats underwent heterotopicSITwith microsurgical technique.Technical modifications included shortening fasting time and supplying energy before surgery,administering optimal volume of crystalloid fluid to the donor and recipient during surgical procedures,reducing mechanical and ischemic injuries to donor intestine,revascularizing small intestinal graft with a combination of conventional aorta to aorta anastomosis and a cuffed portal vein to left renal vein anastomosis which resulted in an acceptably short warm ischemic time,and also an adequate blood supply and drainage of the graft.RESULTS:The average time for the donor surgery was 86min±20min,the mean operative time for the recipient was 115min±20min and warm ischemia time was shortened to 40min±5min,There was a shorter revascularizing time of the graft,the abdominal aorta(AA)to AA anastomosis being21min±10min,and the cuffed portal vein(PV)to the renal vein anastomosis being 5min±5min,The one-week survival rate of 98rats withSITwas88.78%(87/98),without thrombosis and stenosis of anastomosis,The longest survival time of recipient rats was more than389days after SIT,the rats were maintaining normal weight,with perfect intestinal function and intact intestinal histology.CONCLUSION:These modified techniques for SITwould remarkably reduce the complications and improve survival rate in rats,which provided a potentially mor consistent and practical model for experimental and clinical studies.