可量化的受体门静脉干预调节猪辅助性部分肝移植两肝门静脉血流竞争

目的 观察不同程度的受体肝门静脉缩窄对猪辅助性部分肝移植(APLT)受体肝和移植肝门静脉血流竞争的防治作用,探讨一种可量化的受体肝门静脉干预标准.方法 32头健康幼猪按体重相近原则配对,取右半肝作为供肝,切除受体肝左叶,共行16次APLT.根据移植后受体门静脉缩窄程度,将其分为4组:对照组(n=5,门静脉未行处理),缩窄1/4组(n=4,受体门静脉宽度缩窄1/4),缩窄1/3组(n=4,缩窄1/3)和结扎组(n=3,门静脉结扎).定期观察各组受体肝和移植肝的体积大小、血流状况及组织结构的变化.结果 术中电解质变化各组基本相似,血流动力学变化以对照组和缩窄1/4组较为平稳;各组存活率和最长存活时间均以缩窄1/4组最优;门静脉造影示缩窄1/4组两肝之门静脉均得到较好显影,未见明显造影剂淤积和血管扩张;多普勒超声示各组移植肝门静脉依次增宽,流速分别为0.220、0.293、0.336和0.400 m/s,受体门静脉流速分别为0.275、0.294、0.328和0 m/s;两肝体积、充盈度和包膜紧张度以缩窄1/4组最为适中,坏死程度亦以缩窄1/4组最轻.结论 在供受体体重相近且无明显肝硬化时,为防治APLT门静脉血流竞争,以受体门静脉宽度缩窄1/4较为适宜.

Quantifiable intervention of native portal venin to regulate portal blood flow competition for auxiliary partial liver transplantation in pigs

Objective To explore the preventive and therapeutic effects of narrowing of native portal vein (PV) to varying degrees on the competition of the portal flow between native and graft livers in pigs undergoing auxiliary partial liver transplantation(APLT) ,and try to identify a quantifiable standards of native PV intervention. Methods Thirty-two healthy piglets were paired according to the principle of weight similarity. The right hepatic lobes of grafts were used as donor liver. The left hepatic lobes of hosts were resected, and 16 cases of APLT were completeted. According to the degree of PV intervention, the ani- mals were divided into 4 groups:the control group (n = 5, the PV was not processed), narrowing 1/4 group (n =4,the width of native PV was narrowed by 1/4) ,narrowing 1/3 group (n =4,narrowed by 1/3) ,and ligation group (n = 3, PV was ligated). The sizes of native and graft liver, flow conditions and organization-al structure changes of all receptors were regularly observed. Results The changes in the electrolyte of all groups were similar on the whole, and the change in hemodynamics was more stable in control group and narrowing 1/4 group than other groups. The optimal survival rate and the longest survival time were found in narrowing 1/4 group. In this group, both PVs of the two livers had been better visualized by postopera-tive portal phlebography without obvious contrast agent siltation or vasodilatation. Doppler ultrasound showed that the PVs of graft livers were widened in order,and that portal flow velocity of graft was 0.220,0.293,0.336 and 0.40 m/s ,while native PV velocity was 0.275 ,0.294,0.328 and 0 m/s, respectively. In all groups ,the narrowing 1/4 group had the optimal volume balance between the native and graft livers, best amicula intensity and lightest necrosis in the graft livers. Condnsion It is comparatively suitable to narrow native PV width 1/4 times to prevent functional portal flow competition in APLT when the donor and receptor have approximate weight and no obvious liver cirrhosis.