大鼠异位辅助性肝移植肝的形态及功能变化

目的 :观察大鼠异位辅助性肝移植后的自体肝及辅助肝 (两肝 )的形态及功能改变。　方法 :建立大鼠异位辅助性肝移植模型 ,行 (血流动力学 )核素显像、电镜观察及光镜检测 ,评价术后大鼠生存以及移植肝功能状况。　结果 :大鼠异位辅助性肝移植模型切实可行 ,手术成功率较高 (93.3% )。术后 1周存活率达 80 % ,并能长期存活(>3个月 )。术后行相关检查 ,表明供肝随移植时间延长逐渐萎缩 ,功能逐渐丧失 ,4 5天后已基本无功能。　结论 :异位辅助性肝移植中 ,两肝共存时 ,自体肝的功能基本不受影响 ,随着移植时间延长 ,辅助肝逐渐萎缩。     

辅助性异位部分肝移植治疗急性肝功能衰竭的实验研究

目的：探讨辅助性异位部分肝移植对肝功能衰竭(肝衰)的治疗作用。方法：用家猪配对开展辅助性异位部分肝移植，分两组。A组：受体肝脏保持原状，其肝动脉结扎、门静脉缩窄；供肝植入受体右肝下，仅建立门静脉血供。B组：供肝动脉和门静脉血供均建立，其它手术内容与A组相同。监测各组受体存活情况、肝功能情况、病理及供肝胆汁分泌情况。结果：B组受体3d以上成活率显著高于A组。B组手术前后胆红素无显著改变，A组术后胆红素显著高于术前，术后第2天A组胆红素显著高于B组。B组供肝胆汁分泌良好，肝细胞存活并有活跃的代偿性增生；A组供肝无或仅有少量胆汁分泌，肝细胞大片坏死。两组受体均有术后白蛋白下降、丙氨酸氨基转移酶增高。结论：辅助性异位部分肝移植足以纠正肝衰，在临床可以用相似的方法治疗急性或暴发性肝衰患者。     

原位辅助性部分肝移植治疗门静脉高压症的实验研究

目的在建立猪原位辅助性部分肝移植动物模型基础上,观察该手术对猪肝硬化门静脉高压症的初步治疗效果,为临床开展原位辅助性部分肝移植治疗肝硬化门静脉高压症提供理论及实验依据。方法采用结扎胆总管的方法复制猪胆汁性肝硬化动物模型,建模时间为8周,建模成功6只。另取健康良种幼猪6只作为供体组,参照有关文献进行麻醉、供体手术及供肝修整。术前、术后当天及第7天观察门静脉压力、血胆红素和肝功能,同时用彩色B超检查门静脉最大流速及流量。结果肝移植术后5只受体猪存活。术后第7天彩超观察存活猪两肝门静脉血流动力学情况,发现移植肝门静脉血流比宿主肝门静脉血流增多,移植肝功能良好,移植肝回流通畅。BIL、ALT及AST等指标明显好转,术后第7天开腹测量门静脉压力与术前相比显著降低;术前(20.76±2.43)cmH2O,术中关腹前(17.6±2.33)cmH2O,术后第7天(14.7±2.25)cmH2O。结论原位辅助性部分肝移植术能降低门静脉压力和提供一定肝功能支持,是一种较有希望的治疗肝硬化门静脉高压症的新方法。     

实验性异位肝移植肝脏存活与否的血清自由基变化

目的：观察异位肝移植时移植肝及宿主肝存活与否的血清自由基变化。方法：建立猪右肝下部分肝移植模型。动脉血供相同,部分缩窄宿主门静脉控制两肝门静脉血流,观察入肝血流量对移植肝或宿主肝的影响,检测血清中自由基的变化。结果：所有动物术后血清ＭＯＤ及ＳＯＤ均升高。宿主门静脉无缩窄组（Ｂ组）及缩窄门静脉缩窄１／２组（Ｃ组）,宿主肝或移植肝血供不足发生萎缩,ＭＯＤ含量持续升高,ＳＯＤ持续降低;宿主门静脉缩窄１／     

辅助性肝脏移植的免疫状态与血流动力学研究

目的 :探讨辅助性肝脏移植免疫学与血流动力学特点 ,从成功的辅助性肝脏移植中寻找解决移植物萎缩问题的对策。方法 :分析 3例辅助性肝脏移植患者的免疫学指标、病理学资料、血流动力学参数。结果 :辅助性肝脏移植患者免疫抑制剂浓度相对较低 ,排斥反应次数少 ,强度低。存活良好的辅助性肝移植患者移植肝无明显萎缩 ,移植肝门静脉流速和肝动脉流速略高 ,自身肝门静脉流速升高 ,肝动脉流速降低。结论 :辅助性肝脏移植术后处于免疫低反应状态。辅助性肝脏移植的移植物不萎缩的重要因素是保证充分的门静脉血供和肝动脉血供 ,血流重建的关键是吻合口径的控制和吻合部位的选择 ,不排除低浓度免疫抑制剂对移植肝脏副作用较小的可能     

~(99m)Tc-植酸钠扫描评价猪异位肝移植后两肝功能状况

目的　观察99mTc -植酸钠扫描检测异位肝移植后两肝功能状况。方法　建立猪右肝下部分肝移植模型 ,部分捆绑缩窄宿主门静脉控制两肝门静脉血流 ,术后通过99mTc -植酸钠扫描检测两肝血流量 ,并与组织学相对照 ,观察99mTc -植酸钠扫描的实用价值。结果　99m Tc -植酸钠扫描检测的肝功能状况与组织学结果符合 ,门静脉缩窄 1/3组 (A组 )两肝血流量较均衡 ,移植肝及宿主肝均无萎缩 ,门静脉缩窄 1/2组 (B组 )宿主肝血流量明显低于移植肝 ,宿主肝萎缩 ,门静脉无缩窄组 (C组 )移植肝血流量明显低于宿主肝 ,移植肝萎缩。结论　99m Tc -植酸钠扫描能准确反映异位肝移植后两肝功能状况 ,可作评价两肝功能状况的可靠指标     

辅助性部分肝移植幼猪模型及其肝脏功能再生的评价

目的建立辅助性部分肝移植的幼猪模型,观察和评价原肝与供肝的功能再生情况。方法渐进缩窄原肝门静脉,供肝肝静脉与受体肝尾叶内下腔静脉吻合。供肝植入原肝下内方。对部分受体于术后3d行门静脉造影及血管彩色多普勒超声检查,术后3d、1周行原肝、供肝肝功能检测。结果术后10例受体幼猪存活超过1周,术后1周供肝肝静脉血酶学指标较术后3d改善,但无明显差异（P〉0.05）,血氨指标较术后3d明显改善（P〈0.05）,供肝未见萎缩,不同程度获得了再生,供肝肝功能部分恢复。结论所建立的辅助性部分肝移植幼猪模型,供肝获得了良好的再生,为模拟和研究人类辅助性部分肝移植建立了理想的平台。     

99mTc-植酸钠扫描评价猪异位肝移植后两肝功能状况

目的 观察＾９９ｍＴｃ－植酸的钠扫检测异位肝移植后两肝功能状况。方法 建立猪右肝下部分肝移植模型,部分捆绑缩窄宿主门静脉控制两肝门静脉血流,术后通过＾９９ｍＴｃ－植酸钠扫描检测两肝血流量,并与组织学相对照,观察＾９９ｍＴｃ－植酸钠扫描的实用价值。结果 ＾９９ｍＴｃ－植酸钠扫描检测的肝功能状况与组织学结果符合,门静脉缩窄１／３组（Ａ组）两肝血流量较均衡,移植肝及宿主肝均无萎缩,门静脉缩窄１／２组（Ｂ组）宿主肝血流量明显低于移植肝,宿主肝萎缩,门静脉无缩窄组（Ｃ组）移植肝血流量明显低于宿主肝,移植肝萎缩。结论 ＾９９ｍＴｃ－植酸钠扫描能准确反映异位肝移植后两肝功能状况,可作评价两肝功能状况的可靠指标。     

辅助性肝移植术的护理配合

辅助性肝移植是指在保留患者肝脏或部分肝脏的情况下,将供肝异位或原位植入受体内,以使肝功能衰竭病人得到生命支持或使原肝缺失的代谢,解毒功能得到代偿。辅助性原位部分肝移植手术时间短且没有无肝期,对肾功能及     

新辅助性原位部分肝移植动物模型的建立

目的 建立一种新的猪辅助性部分原位肝移植模型。方法 将供肝左叶在体外修肝时切除,右叶供肝作为移植肝。切除受肝左外叶,右叶供肝肝上下腔静脉与受肝肝上下腔静脉行端侧吻合,供肝门静脉与受肝门静脉行端侧吻合,受体脾动脉在结肠后与供体肝动脉端端吻合,胆总管置管外引流。结果 共进行移植模型5例,成功4例,成功率达80％,模型血流动力学稳定。结论 本移植术式在体外转流下行全肝血流阻断,门静脉淤血明显减轻,阻断时间缩短,可以有效防止受体肝的缺血再灌注损伤。血管处理简单,吻合质量高。术后出血少。成功率高,值得推广。     

完全动脉化辅助性肝移植治疗大鼠急性肝功能衰竭的实验研究

目的　探讨辅助性肝移植门静脉动脉化加肝动脉血供对急性肝功能衰竭治疗作用。方法　切除85 %肝脏诱导大鼠肝衰 ,将 30 %肝脏移植于残肝下方 ,通过右肾动脉行移植肝门静脉动脉化并建立肝动脉血供。观察肝衰组和移植组大鼠存活率、肝功能和结构改变。结果　移植组 2周存活率为 73 3% ,肝衰组 4 8h存活率 0 % (P <0 0 5 )。移植术后 14d残肝明显增生 ,肝功恢复正常 ,移植肝萎缩纤维化。结论　辅助性肝移植门静脉动脉化为急性肝功衰竭提供了有效的支持作用 ,使原肝再生功能恢复而移植肝萎缩     

原位肝移植早期移植肝功能的临床评价

目的评价原位肝移植术后早期移植肝的功能状况。方法选择接受原位肝移植术的患者20例(连续病例)。分别于9个时间点测定血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、乳酸脱氢酶(LDH)水平。供肝于冷缺血末期常规进行组织病理学检查。根据肝移植术后72 h内ALT和(或)AST水平(1 500 IU/L为界),将20例患者分为初期移植物功能不良(IPGF)组和非IPGF组,比较两组患者各时间点的ALT、AST、LDH水平,并进行相关性分析。结果20例患者中IPGF组7例,非IPGF组13例。供肝冷缺血末期病理检查显示,IPGF组中4例有轻度大泡型脂肪变性,而非IPGF组中未见脂肪变性(P=0.007)。IPGF组血清ALT水平于再灌注后3、6 h显著高于非IPGF组,其血清AST水平在再灌注后1、3、6、12 h时间点显著高于非IPGF组,而LDH在再灌注后1、3、6 h时间点显著高于非IPGF组(P均<0.05);LDH与ALT(r=0.948,P<0.001)及AST(r=0.646,P<0.01)呈显著正相关。结论供肝脂肪变性对原位肝移植后移植肝功能不良有直接影响;血清AST和ALT水平仍是反映早期移植肝功能状况的可靠指标;LDH与ALT和AST存在良好的相关性,可在一定程度上反映出术后早期移植肝功能情况。     

肝移植中受体肝动脉间置血管的异位重建技巧和方法

Background  At present, revascularization is still one of the most critical technologies in orthotopic liver transplantation (OLT). Hepatic artery (HA) variations occur frequently in both donors and recipients. Moreover, there are always some pathological changes in the recipient hepatic artery. If handled improperly, it may cause complications after anastomosis. Therefore, arterial conduit could be used in primary OLT, re-OLT and multiple-OLT. This study aimed to investigate the indications, methods and techniques with usage of arterial conduit for HA revascularization during adult OLT.

Methods  We reviewed 1200 patients of consecutive OLTs performed during 2000–2009 in the First Affiliated Hospital of Sun Yat-sen University. Of these patients, 48 recipients with artery variations received HA revascularization with usage of arterial conduit and special postoperative managements. The indications, methods, techniques, and the managements of postoperative complications in adult OLT with usage of arterial conduit for HA revascularization were analyzed.

Results  In 48 cases with artery bypass, the arterial conduit were anastomosed between donor hepatic artery and recipient infrarenal aorta (n=32), between donor hepatic artery and recipient suprarenal aorta (n=10), and between donor upper abdominal organ cluster artery and recipient suprarenal aorta (n=6). The technique was applied in 4% (48/1200 cases) of the whole OLTs performed in the same period, and the patency rate of the conduits was 100%. Forty patients (83.3%) survived, and the average survival time was 3.9 years. Eight patients (16.7%) died (all due to tumor recurrence), while the average survival time was 1.2 years. All these patients have not experienced artery-related complications in their survival time.

Conclusions  When recipient HA has variations or pathological changes in OLT, the donor artery should be anastomosed to recipient abdominal aorta with an arterial conduit to achieve satisfactory outcomes. For arterial anastomosis can not be routinely performed, donor iliac artery as a conduit to be anastomosed with the recipient abdominal aorta is safe and effective.

     

猪辅助性异位肝移植的实验研究

我院于1995年5月－12月进行猪辅助异位肝移植10次，供体取减体右肝，切除胆囊和左侧二叶肝。移植肝植于受体猪的右肝下，供肝的肝上下腔静脉与受体肝下下腔静脉端侧吻合，供肝的门静脉与受体门静脉端侧吻合。供肝肝动脉与受体主动脉端吻合。供肝胆总管与受体十二指肠吻合。10例手术均成功。术后生存2．5h－4天5例，另4例生存健康，2例在3个月处死，2例在6个月处死，证明移植肝存活。成功的体会是：1、血管吻合是辅助肝移植成功的关键；2、移植肝重量与受体体重比例最好是在1％左右；3、谷丙转氨酶、总胆汁酸、血氨和总胆固醇可作为实验动物的参考指标。     

Early experiences on living donor liver transplantation in China: multicenter report

Background Because of the lack of brain death laws in China, the proportion of cadaveric organ donation is low. Many patients with end-stage liver disease die waiting for a suitable donor. Living donor liver transplantation （LDLT） would reduce the current discrepancy between the number of patients on the transplant waiting list and the number of available organ donors. We describe the early experience of LDLT in the mainland of China based on data from five liver transplant centers. Methods Between January 2001 and October 2003, 45 patients with end-stage liver disease received LDLT at five centers in China. The indication and timing, surgical techniques and complications, nonsurgical issues including rejection, infection, and advantages of LDLT in the series were reviewed. Actuarial patient and graft survival rates were calculated by using the Kaplan-Meier product-limit estimate. Statistical analysis was completed by using SPSS 10.0. Results All LDLT recipients were cirrhotic patients, except for one man with fulminant hepatic failure. Among the 45 cases of LDLT, 35 （77.8%） were performed in one center （the First Affiliated Hospital of Nanjing Medical University）. The overall 1 and 3 year survival rate of the recipients was 93.1% and 92.0%, respectively. Of the 45 LDLT donors, there were 3 cases of biliary leakage, 2 subphrenic collections, 1 fat liquefaction around the incision and 1 biliary peritonitis after T tube removal. All donors recovered completely. Conclusions LDLT provides an excellent approach to addressing the problem of donor shortage in China even though the operation is complicated, uncompromising and difficult with respect to the safety of the donors and receptors. Despite early technical hurdles having been overcome, perfection of technique is still necessarily. At present, LDLT is a good choice for the patients with irreversible liver disease.     

背驮式原位肝移植尸体供肝切取及修整

1995年9月至1996年8月,施行了2例背驮式原位肝移植,尸体用肝原位冷灌注的方法与肾一起切取。移植物开始用WMO-1号液灌注,然后用UW液灌注。第2例是9岁的患儿,接受了减体积的原位肝移植,切除供体肝左叶,右叶用于移植,术后移植肝肝功能恢复正常。其中1例存活近2年。     

大鼠肝移植术后肝脏再生

目的：研究不同体积大鼠肝脏移植后肝的再生性变化。方法：利用大鼠全肝原位移植和减体积肝移植模型,将不同体积的肝移植给体积相同的受体,观察术后移植肝的体积变化及超微结构的变化。结果：供体肝脏与受体肝脏重量相同,移植术后无明显变化,而供体肝脏小于受体肝脏,移植后迅速生长,7d可接近原受体肝脏的大小。结论：大鼠肝脏移植后再生能力增强,肝脏再生的大小取决于受体肝脏的大小,而与原\供体肝脏大小无关。     

三袖套法大鼠减体积肝移植模型的建立

目的：建立简便实用的大鼠减体积肝移植模型。方法：切除供体大鼠肝脏体积的６８％后移植给受体大鼠，用袖套法吻合肝上下腔静脉，门静脉及肝下下腔静脉。结果：共施行减体积肝移植手术３６例，术后２４ｈ存活率９１．７％，７ｄ存活率５８．３％，７ｄ移植肝重量达原受体大鼠肝脏的７８．７％，１４ｄ，２１ｄ分别达到１０１．６％与１０２．１％，结论：三袖套法大鼠减体积肝移植模型操作简单，稳定可靠，重复性好，是一种理想的动     

Liver retransplantation: a single-centre experience

Background The curative effect of liver transplantation for patients with end-stage liver disease was encouraging in recent years and the 5-year patient survival rate can reach up to 70%. However, some patients might lose grafts due to a variety of reasons, including bile duct complications, vascular complications, primary non-function, graft rejection and disease recurrence etc. Liver retransplantation （re-LT） was the only available means for those patients whose initial grafts had failed, but the inferior outcomes of re-LT compared to primary liver transplantation （PLT） continue to be a major concern. This study aimed to analyze the indications for re-LT, optimal timing of re-LT, and strategies to improve the survival rate after re-LT.
Methods From January 2001 to December 2006, we performed 738 liver transplants and 39 re-LT （5.3%） at our center. A retrospective analysis was performed to identify factors （indication for re-LT, preoperative score of model for end-stage liver disease （MELD）, interval to re-LT from primary liver transplantation, methods of vascular and biliary reconstruction and common causes of death） associated with survival.
Results Mean follow-up period was 1.8 years （1 to 5 years）. Patients with MELD score less than 20 were better than those whose MELD score was 〉20 and MELD score〉30 （1-year survival, 80.0% versus 50.0% and 3/5）. The perioperative survival rate of patients who received re-LT at an interval of more than 30 days and less than 8 days after the initial transplantation was higher than those who received retransplantation between 8 to 30 days following the first operation （88.5% and 74.3% versus 50.0%）. The main causes of death were infection （60.0%）, multiple organ failure （20.0%）, vascular complications （10.0%） and biliary fistula （10.0%） in perioperative period. The overall patient survival rate of 1-month, 6-month and 1-year was 80.0%, 76.7% and 66.7%, respectively.
Conclusions Our study suggested the favorable results aft