大鼠肝移植术中供肝再灌注不良的原因分析及预防措施

目的：探讨大鼠肝移植手术中供肝再灌注不良的原因及相应的预防措施。方法：大鼠原位肝移植分两个阶段进行，第一阶段为实验初期组（n=100），第二阶段为实验后期组（n=100），比较两组手术中引起供肝再灌注不良原因的差别，从中找出预防供肝再灌注不良的措施。结果：实验初期组和实验后期组的冷缺血时间、无肝期、肝下下腔静脉（IVC）阻断时间、供者手术时间、受者手术时间相比，均有显著性差异（P〈0．01）；肝上IVC吻合、门静脉（PV）和IVC吻合、冷灌注过程中供肝气体栓塞、无肝期超过25min和肝损伤引起供肝再灌注不良的发生率两组相比均有显著性差异（P〈0．05或P〈0．01）。结论：提高手术熟练程度，缩短手术时间，预防手术中再灌注不良因素的发生是确保供肝再灌注良好的基础。

The causes and preventive measures of donor liver ma-lreperfusion in the operation of orthotopic liver transplantation

Objective: To explore the causes and preventive measures of donor liver mal-reperfusion in the operation of orthotopic liver transplantation. Methods: Two hundrend cases of orthotopic liver transplantation in rats were divided into group A(anterior 100 transplantations) and group B(posterior 100 transplantations) to compare their incidences of liver mal-reperfusion. Results: There were significant differences in the times of cold ischemia,anhepatic phase,infrahepatic vena cava(IVC) blocking,donor operation and recipient operation,respectively,between group A and group B.The incidences of donor liver mal-reperfusion in the operation of orthotopic liver transplantation caused by factors such as the anastomoses of superahepatic vena cava(SVC),portal vein(PV) and IVC,the gaseous embolism during cold reperfusion,the period of anhepatic phase over 25 minutes and the injury of donor liver were significantly different between group A and group B. Conclusion: Advanced techniques of the operator,shortened time of the operation,and avoiding the factors that will cause mal-reperfusion are the prerequisites to ensure good donor liver reperfusion in the operation of orthotopic liver transplantation.