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     

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。     

~(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     

APA微囊乳猪肝细胞血液灌流治疗FHF大鼠的实验研究

暴发性肝功能衰竭（FHF）是一种病死率极高的危重病，肝移植虽有效，但目前在国内难以推广。近年来，用人工肝辅助装置提高FHF生存率取得一定效果。我们在微囊肝细胞同种腹腔内移植治疗FHF大鼠的基础上，进行微囊乳猪肝细胞血液灌流治疗FHF大鼠研究。我们应用Seglen’s胶原酶原位腹主动脉，门静脉双重灌注法分离乳猪肝细胞，细胞产量为8．98士0．53ml。（7X10’个／mL），存活率为84．6％。应用静脉液滴法制成海藻酸钠一聚赖氨酸一海藻酸钠（APA）微囊肝细胞。将SD大鼠分为3组，A组为微囊肝细胞灌流组，B组为空囊灌流组，C组为非…     

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。     

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／     

小体积肝移植损伤机制的实验观察

目的 探讨小体积移植肝损伤机制.方法 采用肝周骨骼化的去神经解剖、肝切除和原位灌注建立巴马小型猪不同移植量肝移植模型.分为3组(n=5):(1)A组:原位肝移植组;(2)B组:右半肝供肝肝部分移植组;(3)C组:右中叶和尾状叶供肝部分肝移植组.移植后观察动物7 d存活率,动态监测门静脉压(PVP)、门静脉血流量(PBF)以及移植肝组织学病理改变.结果 巴马小型猪不同移植量肝移植7 d存活率分别为:A组100%(5/5);B组100%(5/5)和C组20%(1/5).C组移植肝复流后PVP立即升高,高峰达(28.6±2.07)mm Hg,复流后1 h单位肝组织PBF达(3.56±0.11)ml·min-1·g-1.C组移植肝组织病理改变严重,包括肝窦淤血、出血,肝细胞气球样变或肝细胞坏死,内皮细胞脱落,狄氏间隙增宽或消失以及明显的细胞凋亡.结论 小体积肝移植中门静脉过度灌流和急性门静脉高压是移植肝的主要病因学机制.     

肝移植术围手术期脾亢的处理

目的:观察原位肝移植术后脾功能亢进(脾亢) 的变化,探讨脾亢患者肝移植的处理方法.方法:回顾分析5年内我院115例接受肝移植手术、符合入选条件的脾脏切除或脾动脉结扎患者,将15例作为实验组(A组),其中11例在术前、4例在术中行脾脏切除术或脾动脉结扎术;将68例年龄匹配的同期未切脾肝移植受体随机选为对照组(B组). 分析术后急性排斥反应发生率、血小板计数、肺部感染发生率以及移植肝门静脉肝动脉血流量比(PVF/HAF)的变化规律.结果:急性排斥反应发生率在A组为0,B组为15%,B组明显升高但与A组相比无显著性差异;术后A组肺部感染率为85%,显著高于B组的54%(P＜0.05);A组的血小板峰值为(340±158)×109/L,显著高于B组的(249±93)×109/L(P＜0.01);A组血小板计数在25 d达到顶峰,相比B组在21 d没有显著性差异. A组的门静脉肝动脉血流量比值显著低于B组(12±8 vs 24±16,P＜0.05),肝脏动脉血供较为充分.结论:脾亢患者行肝移植术应按照指征行脾切除术. 脾动脉结扎或脾动脉栓塞术对于术后顽固性低血小板者、肝动脉盗血综合症者及门静脉血流量过大者有良好的应用前景.     

保留大鼠半肝动脉血供肝血流安全阻断时限的实验研究

目的探讨门静脉自然转流及非转流情况下保留半肝动脉血供肝血流阻断的安全时限。方法将实验用雄性Wistar大鼠随机分为A、B、C组。A组保留肝左、肝中动脉血供及尾状叶动脉、门静脉血供（约占全肝5%）,夹闭肝左、肝中叶门静脉,结扎肝右叶肝蒂,到预定阻断时相点,恢复肝脏灌流,切除肝右叶及尾状叶,24h后检测ALT、肝脏HE染色（细胞核）阳性面积的平均百分数及术后7d存活率。B组不保留尾状叶动脉、门静脉血供,其他与A组相同。C组完全阻断肝脏入肝血流,肝切除方式及检测指标与A组相同。结果在A、B、C 3组中,A组的阻断形式对肝脏的损害最轻,B组次之,C组最重。A/100、B/40与C/20损害程度相当。结论大鼠门静脉转流下保留半肝动脉血供入肝血流阻断的安全时限是100min,单纯保留半肝动脉血供入肝血流阻断组的安全时限是40min。     

受体来源转染pBLAST2-hHGF质粒肝卵圆细胞对大鼠移植肝肝功能的影响

目的 观察受体来源转染pBLAST2-hHGF质粒肝卵圆细胞(HOC)对受体大鼠术后肝功能的影响.方法 二袖套法复制大鼠原位肝移植模型.实验分对照组(A组)、HOC移植组(B组)、pBLAST2-hHGF/HOC移植组(C组),每组均设受体大鼠60只,A组仅行原位肝移植术,B组术中供肝种植HOC悬液,C组术中供肝种植pBLAST2-hHGF/HOC悬液.动态观察各组大鼠术后的中位生存时间(MST)、肝功能(ALT、DBil、GGT、ALP、XCHE和ALB).结果 A组术后MST明显短于B组和C组,而B组又短于C组;B组和C组大鼠术后肝细胞受损情况弱于A组(P＜0.05),合成功能和排泄功能好于A组(P＜0.05),上述肝功能指标,C组要好于B组(P＜0.05).结论 使用受体来源pBLAST2-hHGF/HOC在移植肝脏内进行种植,可以有效改善移植肝脏的肝功能,并且明显延长受体的术后中位生存时间.     

一氧化氮促释放剂在保护大鼠减体积肝移植后缺血再灌注损伤中的作用

目的:探讨一氧化氮促释放剂(FK409)在保护减体积肝移植大鼠移植肝脏缺血再灌注损伤中的作用。方法:将56对(112只)SD大鼠分为两组,分别为FK409处理组和对照组。其中各组的8对大鼠用于观察存活率,20对用于观察移植后血中肝脏天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、总胆红素、NO水平及移植物内早期生长反应因子-1(EGR-1)蛋白水平的变化。结果:FK409处理组的1周存活率、血清NO水平均高于对照组(P<0.05),ALT、AST及肝组织中的EGR-1蛋白含量则低于对照组(P<0.05)。结论:一氧化氮促释放剂(FK409)能够通过增加NO的合成,来减轻原位减体积肝移植大鼠的再灌注损伤,改善微循环,提高移植肝脏的功能。     

不同肝功能患者肝移植术中血糖、胰岛素和胰高血糖素的变化及相关性

目的 观察不同肝功能患者行肝移植术中血糖、胰岛素、胰高血糖素的变化及其相关性.方法 终末期肝病拟行肝移植患者30例,按Child分级分为A、B、C组、每组10例,静脉吸入复合全身麻醉下行改良背驮式肝移植.于麻醉前、无肝前期、无肝期25 min,下腔静脉开放后5、30、60 min、手术结束时采集动脉血测定血糖(BG)、血胰岛素和胰高血糖素.结果 肝移植术中血糖、胰岛素、胰高血糖素变化显著,患者术中血糖、胰岛素、胰高血糖素在组内差异有显著性(P＞0.01),组间随着Child分级增加可见血糖、胰岛素、胰高血糖素增高.但只有胰高血糖素变化在组间差异有显著性(P＜0.01).术前及无肝前期胰岛素水平和血糖水平呈正相关.r=0.542 P＜0.01;新肝期(新肝5、30、60及术毕)胰岛素水平和血糖水平无相关,r=0.171 P=0.06.结论 肝移植围术期血糖、胰岛素及胰高血糖素变化显著,肝功能ChildB级以上患者术前常伴有胰岛素血症及胰高血糖素血症,高胰高血糖素血症在重症肝炎患者肝移植围术期有重要意义.     

Paediatric liver transplantation: Queen Mary Hospital experience

Ｐａｅｄｉａｔｒｉｃｌｉｖｅｒｔｒａｎｓｐｌａｎｔａｔｉｏｎ：ＱｕｅｅｎＭａｒｙＨｏｓｐｉｔａｌｅｘｐｅｒｉｅｎｃｅＫ．Ｌ．Ｃｈａｎ陈广亮,Ｓ．Ｔ．Ｆａｎ范上达,Ｈ．Ｓａｉｎｇ申陶,Ｗ．Ｉ．Ｗｅｉ伟霖,Ｃ．Ｍ．Ｌｏ卢宠茂Ｎ．Ｓ．Ｔｓｏｉ蔡迅,Ｉ．Ｏ...     

热休克蛋白70对大鼠心脏停搏供体肝移植的保护作用

目的：采用心脏停搏供体大鼠原位肝移植模型,观察热休克蛋白70（HSP70）对心脏停搏后不同时间的供肝缺血再灌注损伤的影响。 方法：以缺血预处理方法诱导大鼠肝脏组织产生HSP70,以预处理(IP)与否及供体心脏停搏45 min或60 min的不同,将供体大鼠分为4组(IP-45,IP-60,C-45和C-60)。于肝移植术后1 h采血检测肝功能,术后1 h及7 d切取肝脏,观察肝脏病理学改变,并观察各组大鼠术后存活时间。结果：缺血预处理后24~48 h,肝组织HSP70表达明显增强;肝移植术后1 h,血清ALT和AST水平IP组明显低于对照(C)组（P<0.05）;术后7 d,IP组移植肝光学显微镜下肝小叶结构完好,汇管区有少量淋巴细胞浸润,C组移植肝则出现了较多的肝细胞坏死和气球样变。C-45和C-60组1周存活率分别为12.5%和0;而IP-45和IP-60组1周存活率分别为62.5%和37.5%。 结论：HSP70明显改善术后肝脏功能和减轻肝脏病理学改变,显著提高心脏停搏供体肝移植的存活率,HSP70对心脏停搏供体肝移植缺血再灌注损伤具有明显保护作用。     

Surgical techniques of arterialized orthotopic liver transplantation in rats

Background  Recently, much attention has been paid to hepatic artery reconstruction in rat liver transplantation, which can prevent bile duct ischemia and preserve better liver structure. In this study, three methods of graft arterialization, including sleeve, cuff, and stent anastomosis, were conducted and the results were compared.
Methods  Orthotopic liver transplantation (OLT) with rearterialization was conducted in 90 rats, which were divided into sleeve, cuff, and stent groups (n=30 in each). Ninety-six rats received OLTs with standardized two-cuff technique without rearterialization as a control. The sleeve technique included an end-to-end anastomosis between the donor common hepatic artery and recipient proper hepatic artery, or between the donor celiac artery and recipient common hepatic artery. Cuff technique involved an anastomosis between the donor common hepatic artery and recipient common hepatic artery. In the stent technique, the recipient hepatic artery and donor hepatic artery were connected using an intraluminal polyethylene stent. The arterial anastomosis time and arterial patency rate in each group were recorded. The liver graft survival and bile duct complication rates were measured.
Results  The total surgical time of OLT with rearterialization was (118.3±12.9) minutes in the sleeve group, (106.2±11.6) minutes in the cuff, (93.8±10.2) minutes in the stent, and (88.2±9.6) minutes in the control. The corresponding anhepatic phase was (19.6±2.8), (19.2±2.2), (18.6±1.8), and (20.0±2.5) minutes respectively in the sleeve, cuff, stent, and control groups. One-week survival rate was 86.5% in the control, and 86.7% in the groups with rearterialization. No significant difference was detected in the survival rate between them (P>0.05). The incidence of biliary complications in non-rearterialized group (17.7%) was significantly higher than that in the rearterialized group (6.7%, P<0.05). No significant difference was found in the incidence of biliary complications among the three rearterialized groups (P>0.05).
Conclusions  The OLT with rearterialization is more physiological than that without rearterialization, and leads to a lower rate of bile duct complications. Among the three methods of rearterialization, sleeve anastomosis is associated with a higher survival rate, allowing less dissection and less injury to the surrounding tissues.

     

生长抑素对成人活体肝移植围术期肝功能的影响及其可能机制的研究

Background The aim of this study was to investigate the possible effect of somatostatin on the liver function of recipients undergoing living donor liver transplantation.Methods Forty recipients were randomized into group A （n=20） and group B （n=20）. Recipients in group A received no somatostatin whereas somatostatin was administrated for recipients in group B perioperatively. Liver function, the plasma concentration of endothelin-1 and nitric oxide, the intragraft expressions of endothelin-1 and inducible nitric oxide syntheses at 2 hours after declamping of the portal vein were compared between the two groups.Results Compared to group A, alanine transaminase values in group B were significantly reduced at 2 hours after portal vein declamping, at the end of the operation and postoperation day 1 （P 〈0.05）, whereas aspartate aminotransferase values in group B decreased at 30 minutes after portal vein clamping, at 2 hours after portal vein declamping and at the end of the operation （P 〈0.05）. Total bilirubin values in group B were reduced significantly at 2 hours after portal vein declamping and at the end of the operation when compared to group A （P 〈0.05）. Intragraft expression of endothelin-1 was significantly downregulated at 2 hours after declamping of the portal vein accompanied with a reduction of plasma concentration of endothelin-1 in the peripheral blood （P 〈0.05）.Conclusions Somatostatin had a protective effect on liver function during the early phase after declamping of portal vein for recipients undergoing living donor liver transplantation, and the possible mechanism might be partially attributed to the downregulation of endothelin-1.     

Effects of portal venous arterialization on acute occlusion of hepatic artery in rats

Background A fatal complication after liver transplantation is anastomotic embolization of the hepatic artery. In order to solve this problem, the portal venous arterialization （PVA） is used to reconstruct the hepatic arterial blood flow. The purpose of this study was to investigate the influence of PVA on rats with acute occlusion of hepatic artery.
Methods Rat PVA models were established and then randomly divided into Group 1 （control group）, Group 2 （jaundice group）, Group 3 （bile duct recanalization group）, and Group 4 （portal vein arterilization group）. Recanalization of the common bile duct and PVA were performed 5 days after bile duct ligation in the rats. The influence of the PVA on general conditions, hepatic changes of structure and function, portal vein pressure and hepatic micrangium were observed for one month.
Results Five days after common bile duct ligation the serum bilirubin, transaminase and alkaline phosphatase levels were significantly increased. Compared with group 1, there was a statistically significant difference （P 〈0.01）. These rats then underwent bile duct recanalization and PVA. After a month, the liver functions and microscopic structures completely returned to normal and, compared with group 1, there was no statistically significant difference in portal vein pressure （P 〉0.05）. Vascular casting samples showed that hepatic sinusoids were slightly thicker and more filled than normal ones and although they had some deformations, the hepatic sinusoids were still distributed around the central vein in radial form.
Conclusion Within a month after operation, bile duct recanalization and PVA do not show obvious adverse effects on liver hemodynamics and hepatic micrangium, and the liver function and microscopic structure can return to normal.     

阻抗微分图在肝硬变患者中的应用

探讨肝硬变患者的门静脉压力,肺动脉压力的变化及其与肝功能损害的关系。方法应用阻抗微分图,测定４７例肝硬变患者的门脉指数、平均肺动脉压、将肝硬变患者的肝功能按Ｃｈｉｌｄ－Ｐｕｇｈ分级（Ａ级１４例,Ｂ级２１例,Ｃ级１２例）,并同时测定动脉血氧分压。结论阻抗微分图可以反映肝硬变患者的肝功能损害程度及门静脉压力,肺动脉压力的变化,可作为一项辅助诊断指标。