CAJ | 학술논문

目的建立标准化的、可行性强且临床贴合性好的小型猪小体积移植肝损伤模型,为小肝综合征的深入研究奠定基础.方法选用巴马小型猪,采用供体体内原位减体积70%的方法(切除肝左外叶、左中叶及大部右中叶),将30%残肝在非静脉转流下行同种异体原位肝移植术.记录动物手术相关数据、手术存活率及小肝7 d存活率,计算术后7 d移植肝再生百分比;监测术中血流动力学及血气改变;采集再灌注后2 h、术后1～7 d的外周血,检测血清总胆红素(TB)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、凝血酶原时间及肌酐(Cr)水平的变化.猪死后当天尸检明确死亡原因.结果实验共完成12对次小型猪小体积肝移植术.所取供肝与受体全肝重量比(GW/RLW)为(28.63±4.42)%,与受体体重比(GW/BW)为(0.73±0.06)%.平均手术时间、无肝期及肝下下腔静脉阻断时间分别为(191.7±14.2)min、(28.3±3.6)min和(45.0±5.8)min.实验动物手术存活率83.33%(10/12),小肝7 d存活率40%(4/10),7 d移植肝再生百分比为(278.06±42.95)%.与无肝前期相比,无肝期动物心率明显加快,平均动脉压、中心静脉压、肛温(RT)、pH、BE值均显著下降,而血清K+显著升高(P<0.01),至关腹前RT、平均动脉压、中心静脉压、K+已基本恢复.血清ALT、AST、PT和Cr均于术后1 d达到峰值,TB于术后第2天达到峰值,与灌注前水平比较具有显著性差异(P<0.01).至术后7 d,除ALT、Cr基本恢复外,TBIL、AST和PT仍维持在较高水平.结论用巴马小型猪建立的非转流下30%体积供肝移植模型,具有标准化程度高、可行性强且临床贴合性好的优点,可作为小体积肝移植物损伤研究的理想大动物模型.
목적 건립표준화적、가행성강차림상첩합성호적소형저소체적이식간손상모형,위소간종합정적심입연구전정기출.방법 선용파마소형저,채용공체체내원위감체적70%적방법(절제간좌외협、좌중협급대부우중협),장30%잔간재비정맥전류하행동충이체원위간이식술.기록동물수술상관수거、수술존활솔급소간7 d존활솔,계산술후7 d이식간재생백분비;감측술중혈류동역학급혈기개변;채집재관주후2 h、술후1～7 d적외주혈,검측혈청총담홍소(TB)、곡병전안매(ALT)、곡초전안매(AST)、응혈매원시간급기항(Cr)수평적변화.저사후당천시검명학사망원인.결과 실험공완성12대차소형저소체적간이식술.소취공간여수체전간중량비(GW/RLW)위(28.63±4.42)%,여수체체중비(GW/BW)위(0.73±0.06)%.평균수술시간、무간기급간하하강정맥조단시간분별위(191.7±14.2)min、(28.3±3.6)min화(45.0±5.8)min.실험동물수술존활솔83.33%(10/12),소간7 d존활솔40%(4/10),7 d이식간재생백분비위(278.06±42.95)%.여무간전기상비,무간기동물심솔명현가쾌,평균동맥압、중심정맥압、항온(RT)、pH、BE치균현저하강,이혈청K+현저승고(P<0.01),지관복전RT、평균동맥압、중심정맥압、K+이기본회복.혈청ALT、AST、PT화Cr균우술후1 d체도봉치,TB우술후제2천체도봉치,여관주전수평비교구유현저성차이(P<0.01).지술후7 d,제ALT、Cr기본회복외,TBIL、AST화PT잉유지재교고수평.결론 용파마소형저건립적비전류하30%체적공간이식모형,구유표준화정도고、가행성강차림상첩합성호적우점,가작위소체적간이식물손상연구적이상대동물모형.
Objective To establish small-for-size (SFS) graft injury models in miniature pigs with high standardization, reproducibility and similarity to clinical situation. Methods Ba-Ma miniature pigs were introduced in this study and orthotopic liver transplantations (OLTs) were performed in 12 pigs with 30% liver volume allogeneil grafts (small portion of right paramedian lobe, right lateral lobe and caudate lobe) without veno-venous bypass. The profiles of intra-operational hemodynamics and metabolism were investigated. Animals were observed for 7 days with daily serum biochemistry and coagulation function exam. The survival rate related to operation itself and the SFS grafts were respectively calculated as well as the graft regenerative ratio at post-operational day (POD) 7. Results Graft weight as a percentage of the recipient's native liver weight (GW/RLW) and the total body weight (GW/BW) were (28. 63±4. 42)% and (0. 73±0.06)%. The mean operation time, anhepatic phase, and the time of blockage of infra-hepatic IVC were (191. 7±14. 2) min, (28. 3±3. 6) min, and (45. 0±5. 8) min. The survival rate related to the operation itself and the SFS graft were 83. 33% (10/12) and 40% (4/10), and the graft regenerative ratio at POD7 was (278. 06±42. 95) %. Contrast to the remarkable increase of heart rate and serum potassium during anhepatic phase, the mean arterial pressure, central venous pressure, rectal temperature, PH value and buffer excess had a significant decrease (P<0.01) with a gradual recovery after reperfusioa Serum ALT, AST, PT, Cr, and TB were significantly increased with a peak level at POD1 for the former 4 and POD2 for TB, and then began to decrease and favorably recovered at POD7, but TB, PT, and AST levels were still high when compared to those of prereperfusion (P<0. 05). Conclusion This model of OLT performed with 30% liver volume graft without veno-venous bypass was an ideal large animal model for series studies related to SFS graft injury.