小型猪原位肝移植模型的建立:体外静脉转流的重要性及两种被动静脉转流方式的比较

目的 建立巴马小香猪原位肝移植模型,探究体外静脉转流对于猪肝移植模型建立的重要性.方法 实施以巴马小香猪为实验对象的原位肝移植共30例.供体肝脏游离、灌注、切取以及保存按常规方法进行.受体术中置入左侧髂外静脉、脾静脉/门静脉和左侧颈浅静脉"Y"形插管,用作无肝期的静脉-静脉转流.受体术中肝脏游离完成后阻断门静脉,肝上、肝下下腔静脉后开放左侧髂外静脉、脾静脉/门静脉-左侧颈浅静脉转流.血管和胆道均采取端端吻合.结果 前6例未采取体外静脉-静脉转流的原位肝移植手术的受体术中全部死亡,存活率为0.0%(0/6);采用脾静脉-颈浅静脉转流方式的受体术中存活率为57.1%(8/14),而采用门静脉-颈浅静脉转流方式的受体术中存活率为100.0%(10/10),具有显著性差异(P＜0.05).原位肝移植手术时间平均为6.5 h,受体无肝期平均为(33±12)min.供肝热缺血时间平均为2 min,冷缺血时间平均为130 min.结论 采用左侧髂外静脉、门静脉主干-左侧颈浅静脉转流方式的巴马小香猪原位肝移植模型是具有可重复性好,需要的设备少,更加经济,疗效好,是比较理想的猪肝移植模型.可作为肝移植系列研究的平台.

A simplified orthotopic liver transplantation technique in miniature swine model: importance of venovenous bypass and comparison of two passive venovenous bypasses

Objective To investigate the importance of venovenous bypass in the orthotopic liver transplantation by developing a new technique with VVB in miniature swine model.Methods Thirty OLTs were performed between pairs of Chinese Guangxi BAMA miniature swine.In the donor,cold perfusion in situ,hepatectomy and preserving of the liver in HCA solution were performed by routine method.The venovenous bypass in the recipient,which was portal/splenic vein and external iliac vein were connected with Yshaped way,then joined to the left superficial cervical vein,was established during the anhepatic stage.After that,the liver graft was perfused.The infrahepatic vena cava,liver artery and biliary reconstruction were then performed with end-to-end sutures.Results 0/6 (0.0%)pigs without VVB survived in the OLT,8/14 (57.1%) animals with splenic vein and external iliac vein-left superficial cervical vein bypass survived in the operation,10/10 (100.0%) animals with portal and external iliac vein-left superficial cervical vein bypass survived in the operation (P＜0.05).The mean operation time was 6.5 h and the mean anhepatic time was (33± 12)min.The mean warm ischemia time of the grafts was 2 min and the mean cold ischemia time was 130 min.Conclusion The miniature swine liver transplantation model with VVB is appropriate,simplified and can be used to other liver transplantation experiments.