改良二袖套法大鼠原位肝移植模型的建立

目的:探讨改良二袖套法大鼠原位肝移植模型的建立。方法:在Kamada等的袖套法吻合血管的基础上进行改进,供体门静脉进行肝脏灌注,肝上下腔静脉用缝合法吻合,门静脉和肝下下腔静脉用袖套法吻合,胆总管采用单管内支架胆管端端吻合下进行原位肝移植。结果:供体手术时间34±5.5 min;袖套准备12±6 min;受体手术时间42±6 min;无肝期22±4 min。手术后24 h内死亡4例,因为肝上下腔静脉出血2例,肝下下腔静脉出血1例,门静脉出血1例。手术成功率为93.3%。1 w生存率为88.5%。结论:改进的大鼠原位肝移植术操作简便,手术成功率高,可作为肝移植实验可靠、稳定的动物模型。     

大鼠原位肝移植模型的手术改进

目的 本文结合作者自身的实践体会,详细阐述了用"二袖套"方法建立大鼠原位肝移植模型的手术改进方法,以帮助初学者掌握本技术.方法 将136只健康清洁级雄性SD大鼠随机分为供、受者两组.在Kamada的"二袖套法"大鼠原位肝移植技术基础上进行改进,供者改经腹主动脉进行肝脏冷灌注,供受者肝上下腔静脉用7-0线连续端端吻合,门静脉和肝下下腔静脉用袖套法吻合,胆总管采用单管内支架端端吻合.术后观察受者大鼠存活率,并分析死亡原因.结果 供肝切取时间23～35min,修整供肝时间8～13min,受体无肝期16～19min,胆管插管时间2～3min.受者术后48h存活率为95.5%,1周存活率为89.7%.术后48h内主要死亡原因是出血.存活超过48h者,主要死亡原因为胆管梗阻、胆漏及肝叶坏死.结论 改进的大鼠原位肝移植手术成功率高,可作为肝移植实验研究可靠、稳定的动物模型.     

协同性异种肝移植急性排斥反应模型的探索

目的探索协同性异种肝移植急性排斥反应模型的建立。方法参照Kamada“二袖套法”并加以改良,分别对Wistar-Wistar大鼠（A组）15对及金黄地鼠-Wistar大鼠（B组）21对进行原位肝移植术,术后观察大鼠一般情况,并于第1、3、5、7天时各处死1只取肝脏组织进行病理观察,余留做观察生存时间。结果A、B两组供体手术时间、修肝时间、无肝期分别为（23±3）min、（8±2）min、（45±5）min、（17±2．5）及（46±3）min、（21±2．5）min、（18±2）min,手术成功率分别为81．0％与93.3％。A、B两组生存期分别为27．4±3．4天及5．5±1天。A组术后Williams分级均为0级,B组术后第1天1级,第3天2级,超过第5天均为3级。结论①利用改良Kamada“二袖套法”可建立稳定的金黄地鼠-Wistar异种肝移植模型;②同时建立了协同性急性排斥反应肝移植模型,并为解决供肝来源不足方面提供了研究基础。     

暂时性门体分流对大鼠冷缺血再灌注肝细胞凋亡的保护作用

目的比较门静脉分流和阻断对再灌注后两组大鼠肝细胞凋亡的影响,为临床上选取手术方式减轻移植肝冷缺血再灌注损伤提供参考。方法将动物分为假手术组、分流组和阻断组,制作门颈静脉转流下大鼠冷缺血再灌注模型,观察大鼠的一般情况及术后1h、6h、24h、3d及7d肝脏细胞凋亡的变化。结果分流组与阻断组肝细胞凋亡数于再灌注24h达到高峰,然后逐渐下降,术后相同时间分流组肝细胞凋亡数目明显少于阻断组。结论无肝期门体分流处理可以避免门静脉阻断引起的胃肠、脾脏淤血,减少肝细胞凋亡,在更大程度上保持冷缺血再灌注后肝脏组织结构和功能的完整性。     

罗布麻提取物对大鼠局灶性脑缺血再灌注损伤的保护作用

目的 观察罗布麻提取物（Aplocyilum venetum L Extract,AVE）对大鼠局灶性脑缺血再灌注损伤的保护作用。方法 将雄性Wistar大鼠随机分为假手术组、模型组、AVE（高、低剂量）组和阳性对照组（银杏叶胶囊）,口服给药5d后,采用改良的Ionga法,建立大鼠局灶性脑缺血再灌注损伤模型。再灌注2,4h后对大鼠神经功能障碍进行评分,测量其脑梗死面积、脑含水量。结果 与模型组相比,AVE两个剂量组可以减轻神经症状,缩小缺血面积,并且可以减轻脑水肿。与阳性对照组对比,各指标无显著性差异。结论 AVE对局灶性脑缺血再灌注模型大鼠具有保护作用。     

糖原合成酶激酶-3β抑制剂对肝热缺血再灌注损伤的保护

目的：研究糖原合成酶激酶-3β（GSK-3β）抑制剂TDZD-8对大鼠肝脏热缺血再灌注损伤的保护作用。方法：将大鼠随机分为4组：A组（假手术＋空白对照）、B组（假手术＋TDZD-8）、C组（I／R＋空白对照）和D组（I／R＋TDZD-8,实验组）。通过肝门阻断30min建立大鼠缺血再灌注模型,分别于再灌注后2、12h,每组各选取8只大鼠,测定血清ALT、AST含量,行肝组织形态学检测;TUNEL检测肝细胞凋亡,计算凋亡指数（AI）;采用实时定量PCR方法检测肝Bcl-2mRNA转录水平。结果：预先给予TDZD-8组在缺血再灌注期各时相点肝组织结构受损相应较轻,血清ALT、AST含量及凋亡指数均较低（P〈0．05）;Bcl-2mRNA则显著上升。结论：GSK-3β抑制剂可显著减轻肝脏缺血再灌注损伤程度,上调肝脏Bcl-2mRNA转录,抑制肝细胞凋亡。     

高压氧对急性脑缺血再灌注损伤大鼠血清可溶性粘附分子的影响

目的研究急性脑缺血再灌注损伤大鼠血清可溶性粘附分子水平及高压氧对其的影响。方法64只SD大鼠应用抽签法随机分成8组:正常组、假手术组、缺血再灌注1,3,5 d组、高压氧+缺血再灌注1,3,5 d组,每组8只。参照Pu lsinelli四动脉阻断法建立脑缺血再灌注模型。应用ELISA法检测可溶性细胞间粘附分子-1(sICAM-1),可溶性E选择素(sE-selectin),可溶性L选择素(sL-selectin)水平。结果缺血再灌注1,3,5 d组sICAM-1水平[(24.36±0.96),(27.79±1.45),(28.74±1.36)ng/m l]显著高于假手术组[(22.16±0.45)ng/m l,P<0.01]。缺血再灌注1,5 d组sE-selectin水平[(24.47±7.00),(23.44±4.62)pg/m l]显著高于假手术组[(18.68±2.35)pg/m l,P<0.01]。高压氧+缺血再灌注1,3,5 d组sICAM-1水平[(23.08±0.48),(25.15±0.79),(25.49±0.82)ng/m l]显著低于同期缺血再灌注组(P<0.01)。高压氧+缺血再灌注1,5 d组sE-selectin水平[(17.59±3.60),(17.63±2.28)pg/m l]显著低于同期缺血再灌注组(P<0.01)。结论急性脑缺血再灌注损伤早期行高压氧处理可有效降低血清sICAM-1、sE-selectin水平,高压氧可减轻脑缺血再灌注损伤的炎症反应。     

心脏死亡捐献供肝热缺血再灌注损伤及MRI评价的研究进展

供体严重短缺是制约我国肝移植事业发展的瓶颈,而心脏死亡捐献(DCD)将有效扩大供体来源,但肝脏热缺血再灌注损伤一直困扰着DCD供肝的利用效果。功能MR成像能够无创、准确评价活体肝组织的微观信息变化,并获得动态的定量资料,对进一步认识肝脏热缺血再灌注损伤的机制及其预后评估提供有价值的信息。现就我国DCD供肝现状、肝脏热缺血再灌注损伤及MRI评价予以综述。     

血管活性物质一氧化氮、血栓素A2/前列环素I2与肝脏缺血再灌注损伤

探讨血管活性物质一氧化氮，血栓素A2／前列环素I2在肝脏缺血再灌注损伤中的作用。方法：通过大鼠肝脏缺血再灌注损伤模型，检测再灌注不同时限肝静脉一氧化氮血含量及肝组织血栓A2／前列环素I2含量的变化。结果：肝脏缺血再灌注损伤时，肝静脉血一氧化氮含量明显降低；肝组织血栓素A2升高较前列环素I2更明显，导致血栓素A2／前列环素I2比例持续升高，左旋精氨酸可提高肝静脉一氧化氮含量，谷丙转氨酶有所降低。结论：血管活性物质一氧化氮，血栓素A2／前列环素I2参与了肝脏缺血再灌注损伤。应用具有舒张血管及抗血小板聚集血栓形成的制剂，对减轻再灌注损伤起有益作用。     

大鼠原位肝移植过程中肝损伤与肿瘤坏死因子α的关系

大鼠原位肝移植过程中肝损伤与肿瘤坏死因子α的关系２７１０００泰安解放军第８８医院康俊升王霞吴孟超①丛文铭①关键词肝，移植；缺血再灌注损伤；肿瘤坏死因子中国图书资料分类号Ｒ５６７．３原位肝移植是治疗肝终末期疾患的有效方法之一。然而，目前仍存在着移植器官...     

Hepatic arterial complications in liver transplant recipients treated with pretransplantation chemoembolization for hepatocellular carcinoma

PURPOSE: To compare the prevalence of hepatic arterial complications in patients who underwent hepatic arterial chemoembolization for hepatocellular carcinomas before orthotopic liver transplantation with the prevalence of hepatic arterial complications in the total population of liver transplant recipients. MATERIALS AND METHODS: Forty-seven patients underwent selective hepatic arterial chemoinfusion with mitomycin C, doxorubicin hydrochloride, and cisplatin combined with embolization. The prevalence rates for hepatic arterial complications, including pseudoaneurysm, stenosis, anastomotic disruption, and thrombosis, were tabulated and compared with results in 1,154 patients who underwent orthotopic liver transplantation but not chemoembolization. RESULTS: Of the 47 patients who had undergone preoperative hepatic arterial chemotherapy, 13% developed hepatic arterial complications within a mean of 7 days after transplantation; an 8% prevalence of hepatic arterial thrombosis was observed. Of the 1,154 patients who underwent orthotopic liver transplantation but not chemotherapy, 6% developed hepatic arterial complications; a 5% prevalence of hepatic arterial thrombosis was observed. There was no statistically significant difference in the prevalence rates for thrombosis and complications between the patients who underwent chemoembolization before orthotopic liver transplantation and those who did not. The mean interval between chemotherapy and orthotopic liver transplantation was 111 days (range, 3-428 days). CONCLUSION: Patients who undergo hepatic arterial chemotherapy are not at an increased risk of developing hepatic arterial thrombosis or other hepatic arterial complications after orthotopic liver transplantation.     

Radiolabeled annexin V imaging: diagnosis of allograft rejection in an experimental rodent model of liver transplantation

PURPOSE: To assess the value of imaging rejection-induced apoptosis with technetium 99m and annexin V, a human protein-based radiopharmaceutical used in the diagnosis of acute rejection of a liver transplant, in a well-characterized rodent model of orthotopic liver transplantation. MATERIALS AND METHODS: 99mTc-radiolabeled annexin V was intravenously administered to six allografted (immunologically mismatched) and five isografted (immunologically matched) recipient rats on days 2, 4, and 7 after orthotopic liver transplantation. Animals were imaged 1 hour after injection of 0.2-2.0 mCi (8.0-74.0 MBq) of radiolabeled annexin V by use of clinical nuclear scintigraphic equipment. RESULTS: All animals in the allografted group demonstrated marked increases of 55% and 97% above the activity in the isografted group in hepatic uptake of annexin V on days 4 and 7, respectively. Severe acute rejection was histologically detected in all allografted livers on day 7. There was no histologic evidence of acute rejection in isografted animals. Dynamic hepatobiliary imaging with 99mTc and mebrofenin, an iminodiacetic acid derivative, demonstrated no correlation with the presence or absence of acute rejection or with annexin V uptake. CONCLUSION: Noninvasive imaging with radiolabeled annexin V is more sensitive and specific than imaging with 99mTc-mebrofenin in the diagnosis of acute rejection of a liver transplant.     

经桡动脉置入冠脉支架治疗肝移植术后迂曲型肝动脉狭窄

目的 评价经左侧桡动脉置入冠状动脉(冠脉)支架治疗肝移植术后迂曲型肝动脉狭窄的可行性和疗效.方法 2006年6月至2008年4月我科收治的6例肝移植术后迂曲型肝动脉狭窄患者.狭窄发病于肝移植术后6～110 d,平均47 d.2例患者因右侧股动脉入路置入支架失败改用左侧桡动脉入路,4例患者参考术前CTA直接经左侧桡动脉入路置入支架.合并肝动脉血栓的1例患者置入支架前使用尿激酶50万u溶栓治疗.合并肝内胆道扩张的2例患者同时行胆道穿刺引流术.结果 6例患者支架置入均成功,1例合并肝动脉血栓患者溶栓成功,2例合并肝内胆道扩张患者胆道穿刺引流成功.术后随访36～148 d,中位时间76 d.随访期间彩色多普勒超声检查未见支架狭窄,6例置入支架均通畅,各项肝功能指标好转.结论 经桡动脉置入冠脉支架能够有效治疗肝移植术后迂曲型肝动脉狭窄.     

双引流管技术在四例肝移植术后胆道狭窄中的应用

目的 探讨双引流管技术在治疗肝移植术后胆道狭窄中的应用价值.方法 回顾性分析采用双引流管技术治疗4例肝移植术后胆道狭窄病例的资料.采用经皮经肝穿刺胆道引流介入技术,建立1～2条引流道置入双引流管.结果 4例胆道并发症均患者表现为肝内胆管和胆总管多发狭窄合并胆泥形成.患者平均年龄55岁,供肝冷缺血时间11.4 h、热缺...     

Endovascular treatment with primary stenting of inferior cava vein torsion following orthotopic liver transplantation with modified piggyback technique

Purpose

This study was undertaken to evaluate primary stenting in patients with inferior vena cava torsion after orthotopic liver transplantation performed with modified piggyback technique.

Materials and methods

From November 2003 to October 2010, six patients developed clinical, laboratory and imaging findings suggestive of caval stenosis, after a mean period of 21 days from an orthotopic liver transplantation performed with modified piggyback technique. Vena cavography showed stenosis due to torsion of the inferior vena cava at the anastomoses and a significant caval venous pressure gradient. All patients were treated with primary stenting followed by in-stent angioplasty in three cases.

Results

In all patients, the stents were successfully positioned at the caval anastomosis and the venous gradient pressure fell from a mean value of 10 to 2 mmHg. Signs and symptoms resolved in all six patients. One patient died 3 months after stent placement due to biliary complications. No evidence of recurrence or complications was noted during the follow-up (mean 49 months).

Conclusions

Primary stenting of inferior vena cava stenosis due to torsion of the anastomoses in patients receiving orthotopic liver transplantation with modified piggyback technique is a safe, effective and durable treatment.     

Adrenal hemorrhage after liver transplantation

During orthotopic liver transplantation, ligation and division of the right adrenal vein during recipient hepatectomy may lead to hemorrhagic infarction and/or hematoma formation in the right adrenal gland. Findings in seven liver transplant recipients included initially echogenic or anechoic suprarenal masses on ultrasound scans and inhomogeneous but predominantly hypoattenuating masses on computed tomographic scans. In patients who survived for 4 months or longer, hematomas resolved as early as 20 days and persisted as long as 11 weeks. There was autopsy proof of adrenal hemorrhage in three cases. The adrenal hematomas in this series produced no massive hemorrhages, adrenal insufficiency, or other clinical manifestations. Adrenal hemorrhage after liver transplantation should be recognized and specifically documented, but a hematoma that remains stable in size can be left alone.     

超声监测肝硬化失代偿期OLT患者内脏高动力循环的改变及其意义

目的:分析肝硬化失代偿期患者行原位肝移植术前及术后730天内内脏高动力循环的变化情况,探讨其临床意义.材料和方法:利用彩色多普勒监测83例肝移植患者术前、术后730天内的门静脉、肝动脉、脾动脉血流动力学参数及脾脏大小,并与正常健康组20例对照.结果:(1)门静脉供体段血流频谱早期呈锯齿样改变,门静脉术前最大流速显著低于对照组(P<0.05),术后730天内门静脉供体段最大流速均显著高于对照组(P<0.05).肝动脉阻力指数术前及术后7天内显著高于对照组(P<0.05).(2)脾动脉阻力指数术前检查高于对照组(P<0.05),而术后至730天与对照组无显著差异(P>0.05).术后730天内的脾脏最长径均高于术前及对照组(P<0.05,P<0.01).结论:肝移植早期肝动脉阻力由高到低而门静脉流速由高到低,两者相互之间的变化关系维持了移植肝脏术后总血流量的基本稳定.远期监测中,门静脉高流速、脾肿大情况虽有所下降,但无法恢复到正常状态.     

The use of coronary stent in hepatic artery stenosis after orthotopic liver transplantation

PURPOSE: This retrospective study was undertaken to evaluate the effectiveness of coronary stent placement in hepatic artery stenosis after orthotopic liver transplantation (OLT). MATERIALS AND METHODS: Of 430 consecutive adult orthotopic liver transplant recipients between November 2003 and September 2005, 17 had hepatic artery stenosis (HAS). Fourteen of them underwent coronary stent placement in the HAS. The technical results, complications, hepatic artery patency and clinical outcome were reviewed. RESULTS: Technical and immediate success was 100%. After a mean follow-up of 159.4 days (range, 9-375 days), all patients obtained patent hepatic arteries except 2 patients occurred hepatic artery restenoses at 26 and 45 days after stent placement, respectively. Kaplan-Meier curve of patency showed cumulated stent patency at 3, 6, and 12 months of 78%, 58% and 45%, respectively. During the follow-up, 8 patients survived, 5 died of septic multiple-organ failure, 1 received retransplantation because of refractory biliary infection. Hepatic artery dissection induced by a guiding catheter occurred in one patient and was successfully treated with a coronary stent. CONCLUSION: Hepatic artery stenosis after OLT can be successfully treated with coronary stent placement with low complication rate and an acceptable 1-year hepatic artery patency rate.     

肝移植术后移植物抗宿主病的诊治

目的总结肝移植术后移植物抗宿主病的诊断及治疗经验。方法分析总结3例原位肝移植患者治疗急性移植物抗宿主病的临床经过及实验室检查结果,临床表现、皮肤活检及骨髓穿刺结果作为诊断依据,确诊后停止使用免疫抑制剂。结果例1术后12d出现溶血性贫血,术后3～5周出现不明原因发热、皮疹、全血细胞减少,其间肝功能接近正常,患者最后痊愈出院。例2术后出现腹泻、全血细胞减少、消化道出血,于术后25d死亡,死亡原因为感染、消化道出血。例3术后出现发热、慢性腹泻、皮疹和全血细胞减少,最终死于感染、多器官功能衰竭。结论不明原因发热、皮疹和胃肠道症状应警惕移植物抗宿主病发生。停止使用免疫抑制剂,提高机体免疫力可能为更好的治疗方法。