CAJ | 학술논문

目的探讨体外常温机械灌注对心脏死亡供体捐献(DCD)离体供肝活性保护和质量改善的作用.方法 15头小型猪随机均分为活体组、热缺血组和冷保存组.活体组直接获取供肝,冷保存组与热缺血组猪诱导心脏死亡90 min后获取.获取后,冷保存组供肝4℃保存4h,热缺血组与活体组使用常温机械灌注4h,各组供肝均全血机械复流1h.随后留取复流液及新生胆汁检测肝功能,切取肝及胆总管组织行苏木素-伊红(HE)染色.取活体组及热缺血组各2例供肝行18F标记脱氧葡萄糖(18F-FDG)正电子发射计算机断层显像(PET-CT)扫描,比较灌注前后平均标准摄取值(SUVmean)值.结果热缺血组与冷保存组间的谷丙转氨酶(ALT)、乳酸脱氢酶(LDH)、γ-谷氨酰转肽酶(GGT)结果差异无统计学意义(P＞0.05).热缺血组新生胆汁[(2.67±1.05) ml]多于冷保存组[(0.87±0.34) ml,P＜0.05].热缺血组新生胆汁中总胆红素浓度[(466.15±156.11) μmol/L]高于冷保存组[(160.79±36.69) μmol/L,P＜0.05].两组肝细胞均出现广泛水肿及肝细胞变性,胆道上皮完整性严重破坏,但冷保存组损伤更为严重.正电子发射计算机断层显像(PET-CT)结果显示热缺血组机械灌注后SUVmean值较前升高.结论体外常温机械灌注可明显改善DCD供肝糖代谢和胆汁分泌功能,但对于缺血再灌注损伤无明显减轻作用.
목적 탐토체외상온궤계관주대심장사망공체연헌(DCD)리체공간활성보호화질량개선적작용.방법 15두소형저수궤균분위활체조、열결혈조화랭보존조.활체조직접획취공간,랭보존조여열결혈조저유도심장사망90 min후획취.획취후,랭보존조공간4℃보존4h,열결혈조여활체조사용상온궤계관주4h,각조공간균전혈궤계복류1h.수후류취복류액급신생담즙검측간공능,절취간급담총관조직행소목소-이홍(HE)염색.취활체조급열결혈조각2례공간행18F표기탈양포도당(18F-FDG)정전자발사계산궤단층현상(PET-CT)소묘,비교관주전후평균표준섭취치(SUVmean)치.결과 열결혈조여랭보존조간적곡병전안매(ALT)、유산탈경매(LDH)、γ-곡안선전태매(GGT)결과차이무통계학의의(P＞0.05).열결혈조신생담즙[(2.67±1.05) ml]다우랭보존조[(0.87±0.34) ml,P＜0.05].열결혈조신생담즙중총담홍소농도[(466.15±156.11) μmol/L]고우랭보존조[(160.79±36.69) μmol/L,P＜0.05].량조간세포균출현엄범수종급간세포변성,담도상피완정성엄중파배,단랭보존조손상경위엄중.정전자발사계산궤단층현상(PET-CT)결과현시열결혈조궤계관주후SUVmean치교전승고.결론 체외상온궤계관주가명현개선DCD공간당대사화담즙분비공능,단대우결혈재관주손상무명현감경작용.
Objective To investigate the protection and quality improvement of the ex vivo no-morthermic machine reperfusion for donation after cardiac death (DCD) liver.Methods Fifteen pigs were randomly divided into 3 groups:living donor group,warm isehemia group,and cold preservation group.There was no ischemia injury in living donor group,and in cold preservation group and warm ischemia group cardiac death was induced 90 min before procurement.Livers from cold preservation group were stored at 4℃ for 4 h,and nomorthermic machine perfusion was used in warm ischemia group and living donor group for 4 h with perfusate.Each group was machine reperfused for 1 h with autologous blood before blood samples were collected.Liver tissue and common bile duct samples were fixed for hematoxylin and eosin (HE) staining.F-18-fluoro-deoxy-D-glucose positron emission tomography (18 F-FDG PET) scan was performed on randomly selected 2 cases from both living donor group and warm ischemia group to compare the SUVmean before and after perfusion.Results Significant difference was found in bile output [(2.67 ± 1.05) vs.(0.87 ± 0.34) ml] and total bilirubin concentration [(466.15 ± 156.11) vs.(160.79 ±36.69) μmol/L] between the two groups (P ＜0.05).No significant difference was found in the alanine aminotransferase (ALT),lactate dehydrogenase (LDH) and GGT between two groups (P ＞ 0.05).Cold preservation group showed more severe sinusoidal space swelling,sinusoidal congestion and damage of the biliary epitheliums of common bile duct than warm ischemia group.The increased SUVmean was found after nomorthermic machine reperfusion.Conclusion According to our study,the normothermic machine perfusion improves the DCD liver function of synthesis and secretion of bile; however,it shows no significant protection against ischemia-reperfusion injury.