辅助性肝移植门静脉动脉化治疗大鼠急性肝功能衰竭的实验研究

目的 探讨门静脉动脉化异位辅助肝移植对大鼠急性肝功能衰竭的治疗作用和肝动脉血供对移植肝早期功能的影响。方法 将切除85％肝脏的急性肝功能衰竭大鼠随机分为三组：A组（n=20)，异位辅助肝移植门静脉动脉化加肝动脉血供建立；B组（n=20)，异位辅助肝移植门静脉动脉化；C组（n=10)，为对照组。观察肝衰组和移植组大鼠生存情况、肝功能变化、残肝和移植肝病理结构改变以及肝动脉血供对移植肝早期功能影响。结果 A组和B组大鼠2周生存率分别是85．7％和64．3％，C组大鼠48h存活率为0。移植肝再灌注后，A组胆汁分泌率比B组明显增高（P＜0．05），术后2周内，A组血清ALT、GGT、Tbil值显著降低（与B组比较，P＜0．05）。移植术后14天，A组和B组残肝细胞都明显增生，肝功能恢复正常，而移植肝开始萎缩，肝细胞变性，汇管区有淋巴细胞浸润。结论 辅助肝移植门静脉动脉化为急性肝功能衰竭提供了有效的支持作用，使原肝再生，肝功能恢复正常，而移植肝逐渐萎缩丧失功能。在大鼠辅助肝移植中，肝动脉血供有助于改善移植肝早期功能，防止术后胆道并发症的发生。

Research on heterotopic auxiliary liver transplantation with portal vein arterialization for acute liver failure

Objective To investigate the effects of auxiliary partial heterotopic liver transplantation(APHLT) with portal vein arterialization (PVA)in the treatment of acute liver failure(ALF) and hepatic artery blood supply on the early graft function in rats. Methods SD rats undergoing 85% partial hepatectomy were divided randomly into three groups as follows: group A, APHLT with PVA plus hepatic artery reconstruction (n=20); group B, APHLT with PVA (n=20); group C, control group(n=10).The survival rate,alterations of liver function and structure were studied.Results In group A and group B, the two-week survival rate was 85.7% and 64.3%. In group C,the survival rate in 48 hours was 0. The grafts in group A showed higher bile flow rate and bilirubin excretion than that of in group B (P<0.05).After the transplantation,the values of serum ALT,GGT,Tbil fell obviously in the group A (compared with the group B,P<0.05) .Forteen days after transplantation,the host liver regenerated obviously and the liver function recovered while the graft atrophied gradually,hepatocytes degenerated and lymphocytes infiltrated in the portal area in both group A and B.Conclusion APHLT with PVA provides an exact support for ALF which makes the remnant liver regenerate fully,whereas the graft becomes atrophic. Hepatic artery blood supply can improve early graft function and prevent post-transplant biliary complications in this rat model.