同种大鼠带血管异位脾移植模型的建立

目的　建立同种大鼠带血管异位脾移植的实验模型。方法　远交系Wistar大鼠间行同种大鼠带血管异位脾移植。供脾带门静脉段和腹主动脉段分别与受体的下腔静脉和腹主动脉端—侧吻合 ,供脾异位移植于升结肠旁沟 ,与侧腹壁行三点固定。结果　手术成功率为 69 2 % (18/ 2 6例 ) ,术后 1周存活率为 61 1% (11/ 18例 ) ,2例大鼠获长期存活 (>90d)。脾蒂无一例扭转。组织学检查证实术后早期移植脾存活 ,发生急性排斥反应的时间平均为 3d。结论　建立同种大鼠带血管异位脾移植模型是可行的     

大鼠脾移植诱导特异性免疫耐受效果

目的 比较异位脾移植和原位脾移植诱导特异性免疫耐受的效果.方法 建立大鼠异位脾移植和原位脾移植模型6周后,二期行同源心脏移植,比较移植心脏的存活时间和移植5d后的排斥反应强度.以单纯心脏移植组和心脏移植+环孢菌素组作为对照组.结果 移植心脏存活时间:心脏移植+环孢菌素组＞原位脾移植组＞异位脾移植组＞单纯心脏移植组(P＜0.05).术后第7天排斥反应强度和混合淋巴细胞反应强度测定:心脏移植+环孢菌素组＜原位脾移植组＜异位脾移植组＜单纯心脏移植组(P＜0.05).结论 由于脾脏的生理功能与门静脉系统的回流特点有关,较之于异位脾移植,原位脾移植能更为有效地诱导受体特异性免疫耐受状态.     

应用显微外科技术建立大鼠一期肝肾联合移植模型

目的 探讨应用显微外科技术建立稳定、可靠的大鼠一期肝、肾联合移植模型的手术技巧。方法 SD大鼠78只，39只作供体，39只作受体。供体经腹主动脉以4℃乳酸钠林格注射液同时对供肝和供肾进行原位灌洗。原位肝移植时除肝上下腔静脉缝合外，其余血管重建均采用袖套式吻合；肾移植采用将供肾的血管与受体的同名的血管作端端吻合的大鼠原位左肾移植。结果 共施行大鼠原位肝、肾联合移植手术39例，手术成功率为92．3％，术后最长存活的时间超过12个月。结论 娴熟的显微外科技术、细致的手术操作是建立肝、肾联合移植模型的先决条件。已建立的模型稳定性强、重复性好，适合于多器官移植中移植免疫的基础研究。     

改良"二袖套法"大鼠原位肝移植及早期并发症预防

目的研究大鼠原位肝移植模型的手术技巧及术后并发症的预防及处理。方法采用改良"二袖套法"建立大鼠原位肝移植模型,其中供体、受体各160只。结果在肝移植初期共行手术120对,48 h存活率为46.7%。后期手术40对,48 h存活率95.0%。结论适量的麻醉、熟练的供肝游离灌洗和修整技术以及精细的显微外科技术操作是大鼠原位肝移植的关键。     

大鼠胸腺内移植供体脾细胞使移植肝长期存活的实验研究

本研究探讨大鼠胸腺内移植供体脾细胞在建立特异性供体不反应性中的作用。切取ＴＪＲ／１大鼠脾脏，制成脾细胞悬液，直视下注入到ＳＤ大鼠胸腺内，１０天后取出同一供体肝脏行原位肝移植，术后不用免疫抑制剂。结果半数以上大鼠存活超过１００天，而对照组仅存活９±１．５１天。表明本移植模式能产生特异性供体不反应性。     

骨髓输注减轻大鼠肺移植急性排斥反应的研究

目的 研究供体骨髓细胞输注减轻大鼠肺移植急性排斥反应。方法 应用Cuff技术改进大鼠原位单肺移植模型，同时输注供体骨髓细胞，采集受体鼠外周血动态监测嵌合；存活4周大鼠杀死后切取移植肺进行排斥反应分级，切取脾应用免疫组织化学方法检测组织嵌合。结果 流式细胞术在骨髓输注组外周血中检测到明显的嵌合，在脾脏中得到组织嵌合。骨髓输注组移植肺急性排斥反应明显减轻。结论 肺移植同时输注供体骨髓细胞，可以产生显著的供体细胞与受体细胞嵌合，有效地抑制大鼠肺移植急性排斥反应。     

一种改进大鼠肺移植模型的建立

目的 改进大鼠原位单肺移植实验方法，建立稳定的动物模型。方法 取近交雄性SD大鼠，行原位灌洗和供体心肺联合切取，应用cuff技术吻合肺动、静脉，prolene线连续吻合支气管。术后通过胸部X线和动脉血气分析监测移植肺存活情况。结果 共完成26例大鼠肺移植手术，成功23例．失败3例，手术成功率为88．5％，术后7d存活率为100％。手术操作简便，技术稳定。结论 该模型的改进为肺移植及其免疫学等方面的研究奠定了良好的基础。     

大鼠原位和异位小肠移植慢性排斥反应模型的制作与比较

目的比较大鼠原位和异位小肠移植慢性排斥反应模型的建模效果。方法采用F344(RT11vr)大鼠作为供体,Lewis(RT11)大鼠作为受体,构建异系异位和原位大鼠小肠移植模型(各8只),术后0~14 d给予皮下注射环孢素。观察术后受体的体质量变化及存活时间。采用苏木素-伊红(HE)染色观察肠组织病理学变化,酒精苏木素染色后观察肠组织胶原纤维和弹性纤维的变化。计算两组受体大鼠的成模率。结果异位和原位小肠移植大鼠均能长期存活,大部分超过90 d。原位小肠移植组大鼠术后第3日恢复正常饮食,于术后14 d左右体质量可恢复至术前水平,之后缓慢增长,但大部分原位小肠移植大鼠在术后150 d出现持续的体质量下降,且不能被环孢素逆转。异位小肠移植组大鼠术后第1日恢复进食,于术后25~30 d才能恢复至术前的体质量水平,术后30~90 d期间,体质量逐渐上升并保持在较高水平。原位小肠移植组大鼠术后90 d的小肠组织未出现慢性排斥反应的病理学改变且未见明显纤维化,术后163 d和术后200 d的小肠组织出现慢性排斥反应的病理学改变,且出现移植小肠系膜纤维化。异位小肠移植组大鼠术后90 d和术后200 d的小肠组织均出现典型的慢性排斥反应的病理学改变和移植小肠系膜纤维化。异位小肠移植组全部出现特征性病理改变,成模率为100%,与原位小肠移植组成模率75%比较,差异无统计学意义(P0.05)。结论应用F344→Lewis大鼠组合建立原位和异位小肠移植模型,术后给予小剂量环孢素,均可在术后不同时间点出现慢性排斥反应。与原位大鼠小肠移植模型相比,大鼠异位小肠移植模型建模操作简单,慢性排斥反应成模时间较短,病理改变程度相对一致,更适合用于实验研究。     

供体脾细胞胸腺注射对大鼠肢体移植存活的研究

目的 :通过大鼠肢体移植模型 ,旨在分析供体脾细胞注射对大鼠肢体移植中免疫耐受的诱导作用。方法 :选择雄性Wistar和SD大鼠为供、受体 ,对照组为胸腺注射脾细胞培养液 ,实验组为供体脾细胞注射 ,进行了 1 6例异体肢体移植动物实验。观察大鼠移植肢体排斥反应时间及存活时间。结果 :对照组肢体平均存活时间为 ( 9.38± 1 .92 )d ;实验组移植肢体存活时间为 ( 1 5.38± 2 .97)d。结论 :供体脾细胞胸腺注射大鼠肢体移植术后能够明显延长移植肢体的存活时间。     

大鼠原位肾脏移植模型的显微外科技巧

目的 探讨建立稳定、可靠的大鼠原位肾脏移植模型的显微外科手术技巧。方法供体手术经腹主动脉以4℃乳酸钠林格注射液对供肾进行原位灌洗。受体手术采用将供肾的血管与受体的同名的血管作端端吻合的大鼠原位左肾移植。结果 共施行大鼠原位肾脏移植手术120例，手术成功率为91．5％；非干预组中，同系移植大鼠1个月存活率为82．9％。结论 肾动、静脉和输尿管的重建均采用端端吻合法而无须阻断腹主动脉和下腔静脉，大大减少了对受体循环系统的影响。该模型稳定性强、重复性好，适合于移植免疫的基础研究。     

小鼠小肠移植模型制作的手术技术

目的：为研究小肠移植排斥反应提供良好的动物实验模型,方法：选用BALB／c小鼠进行同种异体异位节段性小肠移植。结果：在施行的210次手术中,模型稳定后的108次小肠移植的手术成功率为74．07％。结论：精细的显微外科手术技术是减少出血,防止血管吻合口并发症和提高手术成功率的保证,掌握麻醉的深浅度,合理的补液以及加强围手术期的管理也不容忽视。     

小鼠异位心脏移植模型的建立

目的：利用优良的小鼠品系，建立小鼠异位心脏移植模型，以优化实验条件，降低实验成本。方法：借大鼠腹内心脏移植Ono术式，将NIH小鼠40只随机分为供、受者，供者心脏的升主动脉和肺动脉分别与受者腹主动脉和下腔静脉行端侧吻合，成功地建立了小鼠异位心脏移植模型。结果：手术操作简便，技术可靠；小鼠异位心脏移植成功16例，失败4例，成功率达80％。结论：该模型的建立，为进一步进行移植及免疫学方面的研究奠定了良好的基础。     

Experimental and clinical possibilities of transplantation of the injured and totally devascularized spleen

The most severe spleen lesions with conquasation and devascularisation of entire organ, when it is practically impossible to do any preservating surgical procedure, are the true indications for the transplantation of this extremely important immunological organ. We have performed the evaluation of the surgical procedure of heterotopic auto transplantation in the 30 dogs with severe spleen lesions. Simulation of totally devascularized spleen with the lesions of V degree was performed by disrupting all segmental blood vessels with deep and long longitudinal transhilar incision. During the 3 months follow-up period, animals were subjected to numerous explorations in order to macroscopically and histologically valuate the implant. In most cases (80-85%) implants had complete vitality with the preservation of normal tissue architecture, while 15-20% of implants had partial or total fibrosis. There were no mortality and no complications after this preservation procedure. The presence of fibrosis in some implants suggests that the implant preparation should be better performed and that transplantation of larger tissue volume is needed. Enriched with this experimental experience we have performed heterotopic auto transplantation in 2 patients with spleen lesion of V degree (car accident and injury at work) with very satisfactory results.     

大鼠腹腔同种异体异位心脏移植模型的建立与改进

目的建立并改进大鼠腹腔同种异体异位心脏移植模型,探讨其可行性及安全性。方法对100只Wistar大鼠腹腔同种异体异位心脏移植模型的麻醉方法、供心灌注切取、受体血管准备、吻合方法等进行了改良,术后统计手术时间及手术成功率。结果供体准备、供心摘取时间共（13±3）min,受体血管准备时间（8±2）min,受体腹主动脉吻合时间（10±2）min,受体下腔静脉吻合时间（7±3）min,供心冷缺血时间（30±6）min。手术成功大鼠恢复血供到开始心室纤颤时间（5±2）s,心室纤颤期为（10±3）s。100只中,成功94只,成功率为94%,死亡6只,包括术中麻醉意外死亡3只,术中误伤心耳出血死亡2只,肺血管结扎处出血死亡1只。结论大鼠腹腔同种异体异位心脏移植模型的操作方法经过改进后,降低了手术难度,手术成功率较高。     

Successful heterotopic heart transplant after cardiopulmonary bypass rescue of an arrested donor heart

Global heart transplantation has declined due to the donor shortage. The use of marginal donors has therefore been reintroduced. According to the history of heart transplantation, heterotopic heart transplant has played an important role in the precyclosporine era. In those circumstances, native heart and donor heart worked together to support each other against rejection or progressive heart failure. However, heterotopic transplantation has complicated surgical techniques and requirements for postoperative surveillance. Most training fellows have limited experience with this approach. At present more than 1000 cardiac surgical centers perform heart transplantation, but only 50 centers have experience in performing-heterotopic procedures. Using mechanical circulatory support for the posttransplant period is well developed in most centers. However, using mechanical circulatory support for heart donor with the intention of rescuing the heart has not been reported. Herein, we report a successful heterotopic heart transplantation after rescue with cardiopulmonary bypass of an arrested donor heart.     

Atypical heart transplantation. Technical considerations. Apropos of a case

A heterotopic heart transplantation was performed on a patient placed on circulatory assistance with a Biomedicus pump for ten days using a heart taken from a donor with situs inversus. In relation to this case, the authors describe the technical procedures allowing transplantation of a heart obtained from a donor with situs inversus into a heterotopic position and an orthotopic position or a normal heart in a recipient with situs inversus. Lastly, in the case of complex cardiac malformations with preservation of the lungs, they present the procedures allowing heart transplantation in cases of situs incertus, anomalies of venous return and transposition of the great vessels.     

脾损伤行脾保留手术的可行性分析

目的：探讨脾损伤后行脾保留的可行性及必要性。方法：59例中单纯粘合剂止血8例（工级）,单纯缝合修补7例（Ⅰ／Ⅱ级）,单纯缝合修补＋粘合胶止血15例（Ⅰ／Ⅱ级）,脾部分切除6例（Ⅱ／Ⅲ级）,脾破裂大网膜捆扎＋脾动脉结扎10例（Ⅱ／Ⅲ级）,原位保留脾蒂＋后腹膜自体脾移植2例（Ⅳ级）,脾切除＋自体脾组织移植1例（Ⅳ级）,DSA下行脾动脉栓塞术（其中部分脾栓塞术PSE7例,脾动脉主干栓塞SAE3例）10例（Ⅰ／Ⅱ／Ⅲ级）。结果：59例脾保留手术均获成功,复查脾组织存活,术后免疫功能指标均正常。结论：脾损伤后行脾保留手术是安全可行的,对于保留和恢复脾脏功能具有重要价值。     

Development of a mouse model for heterotopic limb and composite-tissue transplantation

The mouse remains the most suitable model to study the complexities of the immune system and transplant rejection. The purpose of this study was to describe a new mouse model for heterotopic limb and composite tissue transplantation. Eighteen procedures were performed, including 10 heterotopic lower hind limb, four vascularized skin, and four vascularized muscle transplantations. Three transplants were allogeneic, and the rest were syngeneic. All successful syngeneic transplants were harvested at 11 days postoperatively, except for one skin and one limb transplant that were followed for over 30 days. The allogeneic transplants showed signs of rejection between 7 to 11 days postoperatively. Results of mixed lymphocyte culture (p < 0.05) and histology evaluations from the allogeneic recipients were consistent with acute rejection as the cause of allograft loss. The mortality rate was 16.7 percent, and the overall success rate was 72.2 percent. Details of the operative procedure are described, and important technical factors are discussed.     

Heterotopic ossification of five large joints in a patient who had undergone lung transplantation and 72 days of artificial ventilation

Summary A 37-year-old woman had intensive care for 105 days and artificial ventilation for 72 days because of a lung transplantation and multiple postoperative complications. She developed severe heterotopic ossification of both shoulders, the right elbow and both hip joints. Owing to complete joint stiffness, she was immobilized and unable to eat or drink without help. Operative treatment was performed in two procedures. The right shoulder and right elbow were operated on first; the right hip and later the left hip were operated on after recovery from the previous surgical procedures. After 22 months, there was a good functional result; the patient took part in all activities of daily life and was pain-free. The present knowledge on heterotopic ossifications is summarized, as well as possible prophylactic measurements.