大鼠原位肝移植术后早期死亡的原因分析及处理策略

目的通过建立大鼠原位肝移植（orthotopic liver transplantation,OLT）模型,分析术后24 h内大鼠死亡的原因,并探索改进方法。方法采用改良Kamada二袖套法制作大鼠OLT模型300只,记录OLT手术各阶段所用的时间及大鼠术后的生存时间。按生存时间将大鼠进行分组：术中死亡组、〈6 h组、6-24 h组及〉24 h组。比较4组大鼠OLT中各手术阶段的时间,并分析术后大鼠生存时间短于24 h的原因,以探索改进策略。结果300只大鼠OLT模型中,于术中死亡37只,占12.33%;术后6 h内死亡51只,占17.00%;术后6-24 h内死亡76只,占25.33%;术后24 h时仍存活136只,占45.34%。〈6 h组大鼠的前3位死因依次为术中失血过多、术后出血及血管栓塞,分别占27.45%（14/51）、27.45%（14/51）及15.69%（8/51）;6-24 h组大鼠的前3位死因依次为血管狭窄、术后出血及肺水肿,分别占27.63%（21/76）、21.05%（16/76）及19.74%（15/76）。4组大鼠的冷缺血时间和无肝期均不同或不全相同（P〈0.05）,术中死亡组的冷缺血时间长于其余3组（P〈0.05）,且〉24 h组的冷缺血时间短于〈6组和6-24组（P〈0.05）;术中死亡组的无肝期长于其余3组（P〈0.05）。结论导致OLT早期死亡的原因有很多,无肝期及冷缺血时间过长、术中及术后出血、血管栓塞、血管狭窄及肺水肿均是关键因素,对于引起上述原因操作的改进有助于提高大鼠OLT的建模成功率及质量。

Analysis of The Death Causes of Postoperative Early-Stage after Orthotopic Liver Transplantation in Rats and Their Solution Strategies

Objective To analyze the death causes of postoperative early-stage after orthotopic liver transplantation （OLT） in rats, and to provide appropriate treatment strategies. Methods Three hundreds of rat OLT models were performed by modified Kamada two-cufftechnique. Operation time of each stage during OLT and postoperative survival time of rats were recorded and analyzed. According to survival time, the rats were divide into 4 groups： intraoperative death group （rats died during operation）, 〈6 hours group, 6-24 hours group, and 〉24 hours group. Then comparison of operation time of each stage during OLT in rats of 4 groups was performed, and reasons of death during 24 hours after OLT were analyzed. Results Of the 300 OLT models, 37 rats died during operation （12.33%）, 51 rats died within 6 hours after operation （17. 00%）, 76 rats died during 6-24 hours after operation （25.33%）, and 136 rats survived longer than 24 hours （45.34%）. The most common death causes of 〈6 hours group were as follows： lose too much blood during the operation （27.45%, 14/51）, postoperative bleeding （27. 45%, 14/51）, and vascular embolization （15.69%,8/51）. However, the most common death causes of 6-24 hours group were as follows： angiostenosis （27. 63%, 21/76）, postoperative bleeding （21.05%, 16/76）, and pulmonary edema （19. 74%, 15/76）. There were significant differences in the cold ischemia time and anhepatic phase among the 4 groups （P〈0. 05）. The cold ischemia time and anhepatic phase of intraoperative death group were longer than those of other 3 groups （P〈 0. 05）, in addition, the cold ischemia time of 〉 24 hours group was shorter than those of other 3 groups （P〈 0. 05）. Conclusions There are many reasons leading to the early death after OLT. The long time of anhepatic phase and the cold ischemia time, intraoperative and postoperative bleeding, thrombosis, angiostenosis, and pulmonary edema are key factors for the improvement of prognosis in rats after OLT op