中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2010年
2期
106-109
,共4页
张宝良%王军%袁庆鑫%刘彤
張寶良%王軍%袁慶鑫%劉彤
장보량%왕군%원경흠%류동
活体供者%再灌注损伤%胆汁淤积
活體供者%再灌註損傷%膽汁淤積
활체공자%재관주손상%담즙어적
Living donors%Reperfusion injury%Cholestasis
目的 探讨大鼠动脉化原位肝移植中供体热缺血时间对移植肝的影响.方法 实验分为4组:对照组(C)和移植组,移植组根据供肝获取前经历供体心脏停搏时间的不同分为三组:热缺血0 min(W0)、热缺血15 min(W15)和热缺血30 min(W30),其后建立近交系大鼠动脉化原位肝移植模型,每组均为30只大鼠,分别于术后3、7、14和30 d处死,每个时间点各取6只大鼠,分别测定移植肝组织学、肝功能的变化.此外,移植组各组随机选取6只大鼠观察长期生存率(＞100 d).结果 随着供肝热缺血时间的延长,移植肝损伤加重,恢复过程延长.移植组和对照组术后3、7、14和30 d血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)变化无显著性差异.血清碱性磷酸酶(ALP)随着供肝热缺血时间的延长逐渐增高,14 d达到高峰后逐渐下降.术后3、7、14和30 d ALP与供肝热缺血时间具有显著相关性.术后热缺血0、15、30 min长期生存率组分别为100.0%(6/6)、83.3%(5/6)、66.7%(4/6),3组间比较差异无统计学意义(P=0.285).结论 肝移植过程中供肝热缺血主要损伤肝细胞,并随着供肝热缺血时间的延长移植肝细胞损伤加重,肝细胞功能恢复早于其形态学恢复.肝移植术后早期存在胆汁淤积,供肝热缺血时间的延长明显加重胆汁淤积的程度,胆汁淤积的恢复明显晚于肝细胞损伤指标的恢复.在热缺血30 min内来自于心脏停搏的供肝肝移植术后是安全的.
目的 探討大鼠動脈化原位肝移植中供體熱缺血時間對移植肝的影響.方法 實驗分為4組:對照組(C)和移植組,移植組根據供肝穫取前經歷供體心髒停搏時間的不同分為三組:熱缺血0 min(W0)、熱缺血15 min(W15)和熱缺血30 min(W30),其後建立近交繫大鼠動脈化原位肝移植模型,每組均為30隻大鼠,分彆于術後3、7、14和30 d處死,每箇時間點各取6隻大鼠,分彆測定移植肝組織學、肝功能的變化.此外,移植組各組隨機選取6隻大鼠觀察長期生存率(＞100 d).結果 隨著供肝熱缺血時間的延長,移植肝損傷加重,恢複過程延長.移植組和對照組術後3、7、14和30 d血清丙氨痠轉氨酶(ALT)、天鼕氨痠轉氨酶(AST)變化無顯著性差異.血清堿性燐痠酶(ALP)隨著供肝熱缺血時間的延長逐漸增高,14 d達到高峰後逐漸下降.術後3、7、14和30 d ALP與供肝熱缺血時間具有顯著相關性.術後熱缺血0、15、30 min長期生存率組分彆為100.0%(6/6)、83.3%(5/6)、66.7%(4/6),3組間比較差異無統計學意義(P=0.285).結論 肝移植過程中供肝熱缺血主要損傷肝細胞,併隨著供肝熱缺血時間的延長移植肝細胞損傷加重,肝細胞功能恢複早于其形態學恢複.肝移植術後早期存在膽汁淤積,供肝熱缺血時間的延長明顯加重膽汁淤積的程度,膽汁淤積的恢複明顯晚于肝細胞損傷指標的恢複.在熱缺血30 min內來自于心髒停搏的供肝肝移植術後是安全的.
목적 탐토대서동맥화원위간이식중공체열결혈시간대이식간적영향.방법 실험분위4조:대조조(C)화이식조,이식조근거공간획취전경력공체심장정박시간적불동분위삼조:열결혈0 min(W0)、열결혈15 min(W15)화열결혈30 min(W30),기후건립근교계대서동맥화원위간이식모형,매조균위30지대서,분별우술후3、7、14화30 d처사,매개시간점각취6지대서,분별측정이식간조직학、간공능적변화.차외,이식조각조수궤선취6지대서관찰장기생존솔(＞100 d).결과 수착공간열결혈시간적연장,이식간손상가중,회복과정연장.이식조화대조조술후3、7、14화30 d혈청병안산전안매(ALT)、천동안산전안매(AST)변화무현저성차이.혈청감성린산매(ALP)수착공간열결혈시간적연장축점증고,14 d체도고봉후축점하강.술후3、7、14화30 d ALP여공간열결혈시간구유현저상관성.술후열결혈0、15、30 min장기생존솔조분별위100.0%(6/6)、83.3%(5/6)、66.7%(4/6),3조간비교차이무통계학의의(P=0.285).결론 간이식과정중공간열결혈주요손상간세포,병수착공간열결혈시간적연장이식간세포손상가중,간세포공능회복조우기형태학회복.간이식술후조기존재담즙어적,공간열결혈시간적연장명현가중담즙어적적정도,담즙어적적회복명현만우간세포손상지표적회복.재열결혈30 min내래자우심장정박적공간간이식술후시안전적.
Objective To study the effect of donor warm ischemia time on liver graft in rat orthotopic liver transplantation with arterial reconstruction.Methods Lewis rats were divided into four groups(n= 30/group) including control group and 3 liver transplantation groups in which cardiac arrest time was respectively 0,15,30 min(W0,W15,W30),then the model of rat orthotopic liver transplantation with arterial reconstruction was established.To evaluate histology,hepatic function,6 rats in each group were sacrificed on 3,7,14 and 30 days after surgery respectively.The long-term survival (longer than 100 days)rate were compared (n=6) among liver transplantation groups.Results Histological studies showed that with increased warm ischemia time,the recovery of liver function delayed,liver parenchyma injury aggravated.There were no significant difference in serum levels of ALT and AST among all groups on 3,7,14 and 30 days after surgery.ALP level elevated with increased warm isehemia time of the graft and peaking on day 14 postoperatively.The correlation between the warm isehemia time of the graft and serum ALP level was observed.The long-term survival of W0,W15 and W30 were 100.0% (6/6),83.3% (5/6),66.7% (4/6) respectively,with liver abscess as the main canse of death.Conclusion Hepatocytes were what most severely injured by the process of warm ischemia.The injury aggravated with increased warm ischemia time.The recovery of liver function was faster than that of the morphology.Cholestasis was evident after liver transplantation at early phase and aggravated with increased warm ischemia time of the graft.Biochemical signs of cholestasis restored slower than markers of hepatocyte injury.It is safe to use a liver graft in transplantation harvested from a donor suffering from a warm ischemia up to 30 minutes.
