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附加门体分流术对小体积移植肝保护作用的实验研究

Protective effects of affiliating portasystemic shunt on graft injury in small-for-size liver transplantation in miniature pigs

摘要:

目的 研究附加门体分流术对小体积移植肝的保护效果.方法 建立巴马小型猪小体积肝移植模型,将15只小型猪平均分为3组:(1)A组,小体积肝移植组(对照组);(2)B组,远端脾肾分流术+小体积肝移植组;(3)C组,肠腔H形分流术+小体积肝移植组.手术后观察动物7 d存活率,动态监测肝功能生化指标、自由门静脉压、门静脉血流量(PBF)以及移植肝组织病理学改变.结果 动物7 d存活率分别为:A组1/5,B组3/5,C组5/5.A组动物移植肝复流后自由门静脉压立即升高,高峰达(28.6±2.07)mm Hg(1 mm Hg=0.133 kPa),复流1 h后单位肝组织PBF达(3.56±0.1 1)ml·min-1·g-1;移植肝组织病理学改变严重,包括肝细胞气球样变或肝细胞坏死、肝窦淤血、肝实质出血.B、c组中动物肝功能酶学指标有所改善.移植肝复流后自由门静脉压显著低于A组水平(P<0.05),PBF保持相对平稳.移植肝组织病理学病变明显减轻.结论 附加门体分流术可能可以避免小体积移植肝的损伤.

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abstracts:

Objectives To evaluate the protective effects of affiliating portasystemie shunt on small-for-size graft in liver transplantation. Methods Fifteen Chinese Bama miniature pigs were divided into three groups: group A (small-for-size liver transplantation ), group B (distal splenorenal shunt + small-for-size liver transplantation) ,and group C( mesocaval H-shape shunt + small-for-size liver transplantation). Animals were followed up for 7 days with survival, dynamical liver function biochemical parameters, liver biopsies, portal venous pressure (PVP) and portal blood flow (PBF). Results Animal survivals were as follows: group A,1/5,group B,3/5 and group C,5/5. Group A resulted in abnormal liver function parameters that were significantly ameliorated in group B and C. The histological examination of graft in group A displayed severe pathologic changes including hepatocyte cacuolar change or necrosis, sinusoidal congestion, parenchymal hemnrrage. Affiliating portasystemie shunt significandy alleviated graft injuries in group B and C. PVP rose and peaked up to 28. 6 mm Hg( 1 nun Hg =0. 133 kPa) ,PBF fluctuated after reperfusian in group A, but group B and C with affiliating protosystemie shunt showed significandy lower PVP and maintained rather stable PBF after reperfusinn. There were also statistical differences in PVP or PBF between group B and C. Conclusions Affdiating portasystemie shunt effectively might protect small-for-size graft from injuries after reperfusion.

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