大鼠肝移植肝动脉重建方法改进的实验研究

目的 构建重建肝动脉血供的大鼠肝移植模型.方法 在经典"二袖套"法的基础上,利用24G静脉留置针外鞘管制作动脉支架管吻合供体腹腔动脉及受体肝总动脉.结果 共进行肝移植26次.所有手术均单人操作完成.手术成功率(存活24 h以上)为92.3%(24/26).动脉吻合时间仅需(1.70±0.46)min.经解剖发现术后第1天及第30天所有动物肝动脉均通畅,搏动良好,各肝叶入口处动脉亦充盈良好.未发现胆道坏死,胰腺坏死或由于周围组织包绕形成的胆道内漏等.结论 利用支架法吻合供体腹腔动脉及受体肝总动脉的方法 是一种操作简便、耗时短、对正常生理干扰小、通畅率高的理想的大鼠肝移植肝动脉重建方法 .     

改良套入缝合重建肝动脉血供的大鼠肝移植模型建立

目的构建一个稳定的重建肝动脉血液供应的大鼠原位肝移植模型。方法在经典"袖套"法的基础上,将供鼠腹腔干与受鼠的右肾动脉行"套入"法微血管吻合,重建肝动脉血液供应。结果共行重建肝动脉血液供应的大鼠原位肝移植40例次,成功37例次,手术成功率92.5%(37/40),动脉吻合时间平均为(4土1.5)min,术后受鼠4周存活率87.5%(35/40),肝动脉4周通畅率94.3%(33/35)。结论建立全血供的大鼠肝移植模型,以经典"双袖套"法为基础,用供鼠腹腔干与受鼠右肾动脉行"套入"法微血管吻合是一种稳定、可靠、可重复性强的方法。     

门脉建立侧袖式大鼠肝/小肠整块联合移植模型

目的 建立大鼠肝、小肠整块联合移植模型.方法 用Wistar大鼠行同种异体肝、小肠整块联合移植.肝肠联合移植整块切取移植物时,保留门静脉完整性,利用供体腹段下腔静脉在门静脉侧壁上建立一侧袖,并安置套管.然后按kamada二套管法行原位肝移植,动脉重建通过供体腹主动脉与受体腹主动脉行端侧吻合以建立肠系膜上动脉及肝固有动脉血供.回肠末端在右下腹造瘘.结果 手术成功率为86%,动物平均存活时间大于30 d.病理组织学检查发现移植肝和小肠结构正常.结论 用门脉建立袖套式血管吻合技术施行大鼠肝、小肠整块联合移植模型是可行的.     

改良法重建肝动脉血供的大鼠原位肝移植模型

目的 建立一种稳定的重建肝动脉血供的大鼠原位肝移植模型，为研究肝移植术后移植免疫、胆道并发症等提供一个更加符合生理的动物模型。方法 以经典的“双袖套”大鼠原位肝移植模型为基础．将带有主动脉的供肝动脉与受体腹主动脉行端侧吻合重建肝动脉血供。结果 共施行重建肝动脉血供的大鼠原位肝移植35例。术后24h动物存活率85．7％。术后1周动物存活率82．9％。结论 用带有主动脉的供肝动脉与受体腹主动脉行端侧吻合重建肝动脉血供的方法稳定可靠，易于标准化。该模型是研究肝移植术后免疫排斥、胆道并发症的理想模型。     

大鼠改良式原位肝移植手术技巧探讨

目的 探讨建立稳定大鼠原位肝移植模型的手术操作技巧. 方法成年雄性SD大鼠200只,体重200～250 g;成年雄性Wistar大鼠60只,体重230～280 g,供体体重小于受体约30 g.其中SD大鼠为供、受体的同基因肝移植70只(SD-SD组),SD、Wistar分别为供、受体的同种异体肝移植60只(SD.Wistar组).采用改良二袖套法行大鼠原位肝移植,充分暴露第一肝门,不翻动肝脏先行门静脉灌注;在体一步法离断肝上下腔静脉,不带膈肌环;吻合肝上下腔静脉采用单线连续缝合;双线牵引法安装门静脉袖套.术后充分补液维持大鼠血液动力学稳定. 结果 供体手术时间(38.2 ±2.5)min,受体手术时间(45.6±3.5)min,无肝期(15.1±2.2)min,手术成功率93%,1周存活率92%,与传统二袖套法比较差异有统计学意义(P＜0.05).SD-SD组手术成功64只,受体存活时间2～9个月,平均145 d;术后约3 d 肝功能恢复正常,肝组织病理无明显变化.SD-Wistar组手术成功57只,受体存活时间8～20 d,平均10.5 d;大鼠于术后3～5 d出现急性排斥反应,未经处理后均死亡. 结论 改良式肝移植操作简便,成功率高,可为大鼠原位肝移植实验提供稳定可靠的动物模型.     

重建肝动脉血供大鼠原位肝移植模型的术式探讨

目的　探讨重建肝动脉血供的大鼠原位肝移植 (OLT)模型的手术操作方法 ,并对几种术式的效果进行了比较。方法　采用重建肝动脉血供的大鼠原位肝移植 60例 ,其中动脉“袖管式微血管缝合法”2 0例 ,动脉“套管法”2 0例和动脉“支架法”2 0例。同期行不吻合肝动脉的经典“二袖套法”96例。结果　各组手术时间 (包括供体手术 ) :“袖管式缝合法”(118.3± 12 .9)min ,“套管法”(10 6.2± 11.6)min ,“支架法”(93 .8± 10 .2 )min ,经典“二袖套法”(88.2± 9.6)min。无肝期均控制在 (2 0 .0± 2 .5 )min。经典“二袖套法”大鼠 1周存活率为 86.5 % (83 /96) ,重建肝动脉血供的大鼠 1周存活率为 86.7% (5 2 /60 )。胆道并发症发生率分别为 17.7% (17/96)和 6.7% (4 /60 )。结论　肝动脉重建的OLT本身并不能延长肝移植大鼠的生存时间 ,而肝动脉重建后可以减少术后胆道并发症的发生率。     

大鼠肾移植动脉套叠吻合技术的改良

目的 建立一种简便、易行的大鼠肾移植动脉吻合技术。方法 Wistar大鼠72只,分别以36只作为供、受体。采用三线(1根导引线和2根固定线)套叠吻合技术,将供体肠系膜上动脉与受体左肾动脉端端吻合;导引线将受体左肾动脉残端套入供体肠系膜上动脉(2mm),2根固定线呈180。对称缝合;所有缝线均穿过供体血管全层,而受体血管仅达外膜,并在吻合过程中适量缩小肠系膜上动脉腔,使套入后两血管相互紧贴、平伏,避免套入血管壁间渗漏出血。结果 36只大鼠动脉吻合均在6～8min内完成,血流开放后肾脏充盈良好。失败2只,其中吻合口出血1只,血栓形成1只,其余34只术后6～30d病理检查示移植肾动脉通畅,无缺血性损伤。结论 改良的动脉套叠吻合技术简便、易行,易掌握,适合在条件比较简陋的实验室开展。     

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。     

建立大鼠部分肝移植动脉化模型的实验研究

目的 建立稳定的大鼠部分肝移植动脉化模型．并观察术后病理变化。方法 采用改良二袖套法建立大鼠部分肝移植模型，并进行供体的腹腔动脉与受体的右肾动脉端端吻合，采用肝穿刺活检技术于术后1d、2d、4d及7d行肝活检。结果 动物术后1周存活率为85．4％。病理组织学检查术后第2天可见细胞核有丝分裂象，第4天偶见细胞核有丝分裂象，第4、7天可见双核细胞。结论 通过技术改进，提高了模型建立的稳定性。肝穿刺活检技术是进行大鼠肝移植术后相关问题研究的简便、安全、可行的方法。肝动脉的重建可能加速了移植肝的术后再生。     

不同品系大鼠之间原位肝移植的实验观察

目的　探讨不同品系大鼠之间原位肝移植耐受或排斥关系。方法　采用KamadaN等双袖套法进行原位肝移植 ;采用OnoK等改良腹腔内吻合法进行异位心脏移植。结果　Wistar→SD、SD→Wistar以及SD→DA大鼠原位肝移植 ,受体鼠存活均超过 180d ;同种组合方式的异位心脏移植供心平均存活 6.3d。给原位肝移植受体大鼠再移植供体源心脏 ,移植心脏存活均超过 15 0d。给原位肝移植受体大鼠再移植第 3品系大鼠心脏 ,移植心脏平均存活 6.8d。结论　Wistar→SD、SD→Wistar以及SD→DA大鼠的移植组合是分离耐受关系。     

Branch patch reconstruction in living donor liver transplantation: arterialization of grafts with replaced type arteries

We developed a hepatic arterialization technique in living donor liver transplantation. The technique was indicated in patients with a left graft from donors with a right hepatic artery originated from superior mesenteric artery or a right graft from donors with a left hepatic artery from left gastric artery. The donor common hepatic and gastroduodenal arteries were split. On the recipient side, left and right hepatic arteries or branches of the right hepatic artery were split, received patch plasty, and anastomosed with the graft arteries under loupe observation. Livers from 25 donors were procured (16 right livers and 9 left livers) using this technique. There were no vascular complications in the donors. Three recipients died due to infectious disease with arterial patency. The remaining 22 recipients survived without hepatic arterial thrombosis. In limited situations, this technique can be adapted for living donor liver transplantation without increasing donor complications.     

Rat model of orthotopic gastric transplantation

INTRODUCTION: We tried to find a better surgical procedure of reconstruction after total gastrectomy. Seventy rats were operated to establish a model of orthotopic gastric transplantations which may also be important for abdominal multivisceral transplantation. OBJECTIVE: To establish a rat model of orthotopic gastric transplantation. METHODS: In the donor operation; after the spleen was resected and the proper hepatic artery ligated, the stomach was infused with cold (0 degrees C to 4 degrees C) sodium lactate Ringer's solution via the aorta. The stomach was resected with its peripheral blood vessels-the celiac trunk, the left gastric artery, the splenic artery, the common hepatic artery, the gastroepiploic artery, and the portal vein. In the recipient operation; after the stomach and the spleen were resected, the donor stomach was implanted. An end-to-side anastomosis was performed for the portal veins. After the end-to-end anastomosis between the donor celiac trunk and the recipient left gastric artery, the blood flow was opened. Then the anastomoses of the duodenum, and donor cardia to the recipient esophagus were performed in end-to-end style. RESULTS: Thirty five operations were performed, in which the success rate in the last 20 cases was 80% (16/20). The average operative time was 2.35 hours. The longest survival time was over 3 months. CONCLUSION: A rat model of orthotopic gastric transplantation was successfully established and provides a method to study abdominal multivisceral transplantation. It also provides a new way for reconstruction after the total gastrectomy.     

成人间活体肝移植肝动脉重建方法和并发症的处理

目的 探讨成人间活体肝移植的肝动脉重建和并发症处理的经验.方法 自2002年1月至2006年7月,共施行50例成人间右半肝活体肝移植.在供受者间肝动脉的重建中,供者右肝动脉与受者右肝动脉吻合24例,与受者肝固有动脉吻合12例,与受者左肝动脉吻合3例,与受者肝总动脉吻合2例,与受者肠系膜上动脉发出的副右肝动脉吻合2例,与受者肝总动脉自体大隐静脉间置搭桥3例.受者腹主动脉与供者右肝动脉自体大隐静脉搭桥2例,用保存的尸体髂血管行受者腹主动脉与供者右肝动脉搭桥2例.供者肝动脉直径1.5～2.5 mm,采用显微外科技术在3.5倍手术放大镜和5～10倍手术显微镜下完成肝动脉重建.结果 50例成人间右半肝活体肝移植中,有2例(4%)分别于术后1d、7d发生肝动脉血栓形成,立即采用自体大隐静脉从肾下腹主动脉至供者右肝动脉搭桥术,恢复供肝血流,痊愈出院.1例术后1.5个月后发生肝动脉血栓形成,随访期无临床症状未行处理.术后和随访期未发现肝动脉狭窄、肝动脉假性动脉瘤等并发症.围手术期未有与肝动脉并发症有关的死亡病例.全部病例获得随访,随访时间2～52个月(中位随访时间9个月),1年实际生存率为92%.结论 选择恰当的肝动脉重建方式和应用显微外科技术可显著降低肝动脉并发症,及时处理肝动脉并发症是保证供肝存活的关键.     

改良的套叠缝合重建肝动脉的大鼠原位肝移植模型

目的 介绍1种简便的套叠缝合重建肝动脉的大鼠原位肝移植模型。方法 采用套叠缝合重建肝动脉的大鼠原位肝移植模型20例。肝移植采用二袖套法，动脉重建利用供肝的肝总动脉与受体的肝固有动脉根部二针套叠缝合方法。结果 本方法建立大鼠原位肝移植模型的手术时间（包括供体手术）和重建动脉的时间明显缩短。大鼠30d存活率和肝动脉的通畅率均为100％。无胆道并发症发生。结论 套叠缝合重建肝动脉的大鼠原位肝移植模型简便、省时、成功率高，且对组织损伤小、更符合受体解剖生理。     

大鼠颈部异位肾移植术

目的建立一种简单、稳定、成功率高的大鼠颈部异位肾移植模型。方法取健康成年雄性近交系清洁级Wistar大鼠208只,体重220～260g,随机配对。整块获取带肾动脉、肾静脉和带膀胱瓣输尿管的供肾,血管重建采用供体肾动脉与受体的左颈总动脉套叠式吻合、供体肾静脉与受体右颈外静脉套管吻合。供肾输尿管远端行膀胱瓣皮肤造口。结果共进行大鼠异位肾移植术104次,其中预实验阶段62次,成功50次（80．6％）,失败12次,主要原因为麻醉意外、动脉吻合口血栓和大出血、静脉空气栓塞、静脉闭塞等;正式实验42次,成功40次（95．2％）,失败2次,分别为迟发性动脉吻合口出血和吻合口血栓引起。手术时间（40士6）min,其中供体手术时间（20±5）min,供肾修整时间（8±2）min;受体手术时间（18±3）min,其中动脉吻合时间（5±2）min,静脉吻合时间（2±1）min。移植肾冷缺血时间（15±3）min。移植术后1周移植肾血供良好,移植肾均长期存活（超过6个月）。6个月时受体大鼠一般状况良好,生长发育正常。结论大鼠颈部异位肾移植操作简便,冷缺血时间短,成功率高。     

An improved model for rat liver transplantation including arterial reconstruction and simplified microvascular suture techniques.

For experimental liver transplantation in the rat, the models that have been used most frequently do not include reconstruction of the arterial blood supply to the liver. In these procedures, specially developed cuff anastomoses rather than the conventional microvascular suture technique are used almost exclusively in the recipient operation, so that the anhepatic time is minimized. In this study the technical details of an improved rat model for orthotopic liver transplantation are described. During the donor operation in this experimental method, the liver is prepared with an arterial pedicle that includes the abdominal segment of the aorta, permitting perfusion in situ of the portal vein as well as the hepatic artery. The transplantation of the excised donor organ into the recipient site is carried out with simplified microvascular suture techniques and includes reconstruction of the arterial supply to the liver. Anastomosis of the bile duct is accomplished by choledocho-choledochostomy with a splint technique and supplemental suturing. For the entire procedure, magnifying glasses with 2- to 2.5-fold magnification are sufficient. When this technique has been mastered, the average duration of the anhepatic phase is about 20 min, well below the critical 30-min limit for survival of the experimental animals. As proficiency increased, the perioperative mortality was reduced to 9.2% (n = 130). With the combination of portal and arterial in situ flushing during the donor operation and the rearterialization of the transplant during the recipient operation, the clinical conditions can be approximated more closely than is possible when the transplanted rat liver is supplied only by the portal vein. Use of microvascular suture techniques, without cuff anastomoses, reduces the need for ex situ handling of the donor organ.     

Combined carotid arteries-aortic arch transplantation in rats: development of a new microsurgical model.

A new microsurgical model of combined carotid arteries-aortic arch transplantation in the rat is described. In this model, the combined carotid arteries-aortic arch were harvested and end-to-end anastomosed to the recipient's right carotid artery using a sleeve anastomosis technique. The total graft ischemia time and in particular the time required to perform the arterial anastomoses was significantly reduced. No surgical failure was encountered. Ten-day graft patency was 100% (15/15). Our study results demonstrated that the sleeve anastomosis technique for combined carotid arteries-aortic arch transplantation in the rat is fast and easy to perform and has a high rate of success.     

Cervical heterotopic small intestinal transplantation in rats using artery sleeve anastomosis

Our goal was to establish a simple and stable cervical heterotopic small intestinal transplantation (SIT) rat model that minimizes mortality. METHODS: The graft was removed en bloc consisting of small intestine, portal vein (PV), and donor superior mesenteric artery. The graft was perfused in situ and the gut lumen irrigated during the operation. The donor artery was end-to-end anastomosed to the recipient left common carotid artery using a sleeve technique, and the donor vein to the recipient right external jugular vein using a cuff technique. The proximal and distal ends of the graft were formed as cervical cutaneous stomas. RESULTS: Among 106 intestinal transplantations, 40 were a formal experimental group, displaying a survival rate of 95%. Surgery lasted 70 +/- 10 minutes. The average time for the arterial anastomosis and the venous anastomosis was 5 +/- 2 minutes and 2 +/- 1 minutes, respectively. Two rats died due to late anastomotic hemorrhage or intestinal fistula; 38 survived more than 6 months. CONCLUSION: The cervical heterotopic technique has the advantages of being easier and faster to perform with shorter cold ischemia time and higher graft survival rate as well as fewer complications.     

Collaboration with microsurgery prevents arterial complications and provides superior success in partial liver transplantation

Hepatic artery thrombosis is the most common technical complication in liver transplantation. The objective of this study was to investigate the arterial complications of partial liver transplantation using microsurgical technique. At a period of 31-months, we participated in a total of 42 right lobes, 7 left lobes, and 1 whole-liver liver transplantations from cadaveric (n = 20) or living (n = 30) donors. Hepatic artery anastomosis was performed using microsurgical techniques. All anastomoses were accomplished successfully. Fifteen patients expired postoperatively and 35 hepatic artery anastomoses remained patent at a mean follow-up period of 10.6 +/- 8.4 months. The mean diameters of the donor and recipient hepatic arteries were 2.9 +/- 1.2 mm and 3.2 +/- 1.1 mm, respectively. Specific technical challenges were encountered during operation in eight cases (16%). We have found that microsurgical techniques are not only useful for a superior anastomosis but also reliable to adapt to vascular anomalies with less arterial complications. complications.