猪辅助性部分肝移植模型制作及比较

目的建立猪的辅助性部分肝移植模型,观察其肝功能和术中血流动力学变化。方法 24头健康良种家猪,体质量23-30 kg,被随机分为供体(n=12)和受体(n=12)。气管插管 全麻,硫喷妥钠静脉维持。移植前切除受体肝左叶,供肝右叶作为植入肝。预实验2例行经体位转流的原位辅助性部分肝移植,对照组(5例)行简易转流下的原位辅助性部分肝移植。模型组(5例)行异位辅助性部分肝移植, 供肝被植入受体肝下间隙,供肝肝上下腔静脉与受体肝下下腔静脉端侧吻合,供肝门静脉与受体门静脉行端侧吻合,供肝肝动脉与受体脾动脉行端端吻合。供肝胆总管置管外引流。结果预实验中行体位静脉转流的原位辅助性部分肝移植的2例受体在肝上下腔静脉阻断后很快陷入血流动力学紊乱死亡。5例行简易静脉转流的原位辅助性部分肝移植的受体,2例在24 h内死亡,1例28 h,2侧超过48 h。而模型组受体 5例中有4例存活超过24 h。AST,ALT指标手术开始至术后24 h呈持续升高。模型组术中血流动力学较其他组稳定。结论该辅助性肝移植模型简明易建且具有不需静脉转流等优点,为研究辅助性部分肝移植原肝和供肝功能及血流变化提供了理想的平台。

Fabrication of auxiliary partial liver transplantation model and comparative study

Objective To establish new model of pig auxiliary partial liver transplantation model and observe the liver function and hemodynamics in pigs. Methods Twenty-four healthy male or female domestic pigs, weighing 23 to 30 kg, were randomly divided into donor(n=12) and recipient(n=12) groups. After intubation, anesthesia was maintained with pentothal sodium, the left lobe of the host liver was resected before transplantation ,the right lobe of doner liver was used as a graft. Two cases were undergone auxiliary partial orthotopic liver transplantation with gravity vein-vein bypass in preliminary experiment. In control group, five cases were undergone auxiliary partial orhotopic liver transplantation with simple vein-vein bypass device. In model group , graft was transplanted into the infrahepatic of space of the host liver, donor suprahepatic inferior vena cava was anastomosed with end-to-side anastomosis method to host infrahepatic inferior vena cava, the dornor's infrahepatic inferior vein was ligated. Donor portal vein was anastomosed with end-to-side mothod to host portal vein, and dornor hepatic artery with end-to-end mothod to host spleen artery. The common bile duct of the donor was intubated and bile was collected with an extracorporeal bag. Results Two recipients received orthotopic partial liver transplantation with gravity veno-venous bypass died soon after suprahepatic inferior vein was blocked. Two recipients used simple veno-venous bypass device during transplantation died within 24 hours,one 28 hours,two more than 48 hours. Four of five recipients of model group without veno-venous bypass survived more than 24 hours, Three more than 48 hours. Both ALT and AST increased during transplantation and postoperative 24 hours . Hemodynamics of model group was steadier than that of other groups. Conclusion The auxiliary partial liver transplantation model set up by us is simple, and need not veno-venous bypass device, which provides good base for studying function and hemodynamics between graft and host liver in auxiliary partial liver transplantation.