改进的大鼠原位肝移植术与相关手术技巧

目的：改进大鼠原位肝移植的手术方式，并总结出相关手术技巧。方法：用改进的二袖套法共建立160例大鼠原位肝移植模型。术中门静脉、肝下下腔静脉用袖套法吻合，肝上下腔静脉用缝合法吻合，胆管内支架法完成胆道重建。结果：采用改进的二袖套法进行大鼠原位肝移植，平均供体手术时间46min，修整供肝时间24min，受体无肝期21min，肝上下腔静脉缝合时间13min，门静脉套管时间3min，肝下下腔静脉套管时间4min．胆管插管时间3min。术中和术后24h内主要死亡原因是气胸、麻醉意外、出血，手术成功率92．5％。存活超过24h者，主要死亡原因为感染、胆道梗阻以及移植肝功能失活。结论：制作大鼠原位肝移植模型需要娴熟的显微外科基本功和耐心细致的手术操作。改进的二袖套法具有无肝期短、手术成功率高的优点，是建立该模型的理想术式。

Improvement in orthotopic liver transplantation in rat and related operation skills

Objective:To improve orthotopic liver transplantation in the rat and conclude related operation skills.Methods:160 cases of orthotopic liver transplantation models in the rat were established by improved two-cuff technique.The anastomosis of portal vein between donor and recipient was performed by cuff technique.The same method was used to anastomose infrahepatic vena cava.The suprahepatic vena cava anastomosis was performed by suture and bile duct anastomosis was completed end to end by Teflon catheter.Results:The average time of donor operation,preparing graft and anhepatic period was 46min,24min and 21min respectively.The anastomosis time of suprahepatic vena cava,portal vein,infrahepatic vena cava, and bile duct was 13min,3min,4min,and 3min respectively.Main reasons for death during operation were pneumothorax,anesthesia and bleeding,and the successful rate of operation was 92.5%.Infection,obstruction of biliary tract and graft failure were attributed to the main causes for mortality after operation.Conclusion:Making orthotopic liver transplantation in the rat requires professional microsurgical techniques and careful operation.The improved two-cuff technique possesses advantages of short anhepatic phase,high operative successful rate,and is an ideal method for establishing this animal model.