CAJ | 학술논문

背景:目前有关活体肝移植后肝脏再生的研究较少.在大鼠肝移植实验中不断改进手术方法和技术,提高肝移植成功率是进行大鼠肝移植研究和获得可靠实验数据的基础.目的:验证以改良方法构建减体积肝移植大鼠模型的有效性.方法:选用健康SD大鼠,70对制备减体积肝移植改良前模型,100对制备减体积肝移植改良后模型.供体为雌性,受体为雄性,供体体质量比受体轻10 g左右.改良前方案采用取下全肝后在修肝盆中进行减体积肝移植.改良后方案如下:供体采用单人裸眼操作,在取肝的过程中即进行减体积操作;修肝时将套管柄置于门静脉和肝下下腔静脉的正前方,将幽门静脉结扎点外翻于套管外并置于套管柄的左侧,即肝脏的左侧;将右肾静脉结扎点外翻于套管外并置于套管柄的右侧,即肝脏的右侧;供肝套管完成后用灌注液对门静脉和肝下下腔静脉进行冲洗;然后以左膈静脉为标识点进行7/0无损伤血管缝线吊线;受体采用双人裸眼配合操作,肝上下腔静脉吻合时,左右固定位点采用"8"字形外翻缝合,后壁和前壁分别采用连续吻合,门静脉和肝下下腔静脉采用改良的双袖套法,胆管支撑管法建立大鼠减体积的稳定模型.结果与结论:改良后供体手术时间为(32+9)min,修肝时间为(6±2)min,受体手术时间为(40±3)min,无肝期时间为(14±3)min.移植成功率为92%,移植后3 d生存率为85%,移植后2周生存率83%.与改良前比较,移植后并发症发生率降低(P<0.05),供肝的冷保存时间缩短(P<0.05).提示改良后的大鼠减体积肝移植模型比较稳定,可靠,移植成功率较高,移植后并发症发生率较低,为研究减体积肝移植后肝脏再生提供了有效的改良手段.
배경:목전유관활체간이식후간장재생적연구교소.재대서간이식실험중불단개진수술방법화기술,제고간이식성공솔시진행대서간이식연구화획득가고실험수거적기출.목적:험증이개량방법구건감체적간이식대서모형적유효성.방법:선용건강SD대서,70대제비감체적간이식개량전모형,100대제비감체적간이식개량후모형.공체위자성,수체위웅성,공체체질량비수체경10 g좌우.개량전방안채용취하전간후재수간분중진행감체적간이식.개량후방안여하:공체채용단인라안조작,재취간적과정중즉진행감체적조작;수간시장투관병치우문정맥화간하하강정맥적정전방,장유문정맥결찰점외번우투관외병치우투관병적좌측,즉간장적좌측;장우신정맥결찰점외번우투관외병치우투관병적우측,즉간장적우측;공간투관완성후용관주액대문정맥화간하하강정맥진행충세;연후이좌격정맥위표식점진행7/0무손상혈관봉선조선;수체채용쌍인라안배합조작,간상하강정맥문합시,좌우고정위점채용"8"자형외번봉합,후벽화전벽분별채용련속문합,문정맥화간하하강정맥채용개량적쌍수투법,담관지탱관법건립대서감체적적은정모형.결과여결론:개량후공체수술시간위(32+9)min,수간시간위(6±2)min,수체수술시간위(40±3)min,무간기시간위(14±3)min.이식성공솔위92%,이식후3 d생존솔위85%,이식후2주생존솔83%.여개량전비교,이식후병발증발생솔강저(P<0.05),공간적랭보존시간축단(P<0.05).제시개량후적대서감체적간이식모형비교은정,가고,이식성공솔교고,이식후병발증발생솔교저,위연구감체적간이식후간장재생제공료유효적개량수단.
BACKGROUND: There are few studies on liver regeneration following living liver transplantation. Improvement of operation methods and techniques and successful rate are the basis for rat liver transplantation study and data acquisition. OBJECTIVE: To investigate the efficacy of improved model of reduced-size liver transplantation in the rat. METHODS: Healthy SD rats were selected. 70 pairs of rats were subjected to reduced-size liver transplantation before modification, and 100 pairs subjected to reduced-size liver transplantation after modification. The donors were female and the recipients were male, and the body mass of donors was 10 g less than the recipients. Operation of donor was performed by only one person with the naked eye, and reduced-size donor liver was performed in the donor operation. The handle of self-made cannula was placed in the front of portal vein and inferior vena cava, respectively, and the tied ligature of pyloric veins was turned inside out of the self-made cannula. Furthermore, the tied ligature was placed in the left of the self-made cannula; the same to inferior vena cava except that the tied ligature of right renal vein was placed in the right of the self-made cannula; the portal vein and inferior vena cava were washed with self-made perfusate respectively. Operation of the receptor was performed by two persons with the naked eye, with improved dual-cuff technique of Kamada and stay pipe of biliary tract, the fixed points of left and right were connected by anastomosis of "8" type with turning inside out while inosculating inferior vena cava. RESULTS AND CONCLUSION: The average modified operation time of the donor and the donor liver preparation time was (32±2) minutes and (6±2) minutes, respectively. The average operation time of the recipient and the anhepatic time was (40±3) minutes and (14±3) minutes, respectively. The general successful rate was 92%; three-day survival rate was 85% and two-week survival rate was 83%. The postoperative complications reduced significantly (P< 0.05), and cold conservation time of donor was shortened (P < 0.05). The modified model of reduced-size liver transplantation was more safe and reliable, with high success rate of liver transplantation and survival rate of recipient. Moreover, the postoperative complications of receptor decreased significantly. It provide an effective method of investigating liver graft regeneration following reduced-size liver transplantation.