经改进同种异体大鼠原位肾移植模型的建立

背景：大鼠肾移植模型是研究人体肾移植后排斥反应最好的方法，但因其需要精细外科技术，难度较大，限制了这一模型的应用。目的：通过阅读大量相关文献，对多种造模手术方式和术中某些操作进行改进，建立稳定、可靠的大鼠原位肾脏移植模型显微外科手术方法。设计、时间及地点：动物观察实验，于2008-09/11在天津市人民医院动物实验室完成。材料：40只健康成年雄性SD大鼠，体质量250~300 g，随机选取20只作为肾移植供体，剩余20只为受体。方法：①对供、受体进行肾血管游离时尽量采用钝性分离。②将供肾原位低温重力灌注，修剪、摘除后低温保存。③受体摘除左肾后行采用肾动、静脉端-端吻合，供体输尿管-受体膀胱浆肌层隧道术进行尿路重建，两点间间断缝合采用6针法吻合。术后小剂量环孢素抗急性排斥反应。 主要观察指标：通过对手术时间、术后死亡率及死亡原因分析，评价术式的合理性及可靠性。结果：总手术时间(150±17) min，热缺血时间(15±2) s，冷缺血时间(55±5) min。3只于1周内死亡，其中麻醉意外1只，吻合口出血死亡1只，输尿管狭窄死亡1只，手术成功率为85%。术后第8天对存活受体鼠行剖腹探查，移植肾均颜色饱满，吻合口无栓塞、狭窄。结论：通过对以往手术方式进行改进，采用肾动、静脉端-端吻合，供体输尿管-受体膀胱浆肌层隧道术进行尿路重建的术式建立了可靠的大鼠原位肾移植模型。

Construction of modified rat orthotopic models of renal transplantation

BACKGROUND: Rat model of renal transplantation is the best way for studying human rejection following renal transplantation. However, the utilization of this model is limited due to refined surgical technique.OBJECTIVE: To explore a microsurgery operation method for constructing a stable, reliable orthotopic renal transplantation model.DESIGN, TIME AND SETTING: The animal observation experiment was performed at the animal laboratory of Tianjin Union Medicine Centre from September to November 2008.MATERIALS: A total of 40 SD rats, weighing 250-300 g, were medially adopted as donators and recipients. METHODS: The renal vessels were separated by blunt separation. The kidneys of donators were infused, removed and conserved at low temperature. To the recipients, the left kidney was removed, and renal blood vessel was anastomosed by ext-ext anastomosis and reconstructed urinary passage by implanting ureter into bladder. 6-point acupuncture was used to suture wound. MAIN OUTCOME MEASURES: The rationality and the authenticity of this operation were evaluated through analyzing the operative time, postoperative death rate and the cause of death.RESULTS: The total time of operation was (150±17) min, with warm ischemia time of (15±2) s and (55±5) min cold ischemia time. Three rats died at the first week after operation, which caused by anesthetic accident, stomatorrhagia and ureterostenoma. The achievement ratio of operation was 85%. At day 8 after operation, exploratory laparotomy of survived rats showed that the transplanted kidney was recovered well without embolism or stenosis at the stoma.CONCLUSION: An orthotopic renal transplantation model of rat is constructed by ext-ext anastomosis and reconstructed urinary passage by implanting ureter into bladder.