摘要
目的采用磁压榨吻合(MCA)技术代替传统缝合法,建立一种无缝线快速吻合肝移植模型,为临床肝移植相关问题研究搭建一个良好的技术平台。方法 SPF级健康雄性SD成年大鼠300只,体重为250~280 g,供、受体各150只。以"双袖套"法为基础,采用MCA行大鼠肝上下腔静脉(SHVC)重建建立大鼠原位肝移植模型。练习分3个阶段,分为前期40对,中期40对,后期70对。观察并记录各阶段大鼠肝移植术手术时间及术后1、5 d存活率;分析手术失败的原因并改良手术技巧。结果供体手术时间从前期(45.0±5.0)min减少至后期(22.0±3.0)min,无肝期从(28.5±5.0)min减少至(11.8±3.1)min,受体手术时间从(76.1±7.0)min减少至(47.7±2.9)min。前期、中期、后期的术后1、5 d存活率分别为25%(10/40)、80%(32/40)、97%(68/70)和5%(2/40)、45%(18/40)、83%(58/70)。前期大鼠肝移植手术失败主要是由于无肝期长、门静脉(PV)-肝下下腔静脉(IHVC)吻合失败、术中出血多,受体多数未完成手术或术后2~4 h死亡。中、后期大鼠肝移植手术失败主要是由于PV-IHVC吻合失败。结论采用改良的MCA可快速吻合SHVC,提高移植成功率,为初学者减少练习难度与周期,建立了一种理想的肝移植模型。
Objective Magnetic compression anastomosis （MCA） was adopted to substitute traditional suturing method and establish a suturelcss and rapid anastomosis liver transplantation （LT） model, aiming to establish a favorable technical platform for studying LT-related problems in clinical practice. Methods A total of 300 healthy male SD adult rats （SPF grade）, weighed 250-280 g, were evenly divided into the donors （n=150） and recipients （n=150）. Based upon the two-cuff technique, the rat models of orthotopic LT were established by the reconstruction of suprahepatic inferior vena cava （SHVC） using MCA. Practice stages were subject to the early- （40 pairs）, middle- （40 pairs） and advanced-stage （70 pairs）. The operation time and postoperative 1-, 5-d survival rates of the rats during each stage were observed and recorded. The causes of surgical failure were analyzed to improve the surgical skills. Results The operation time of the donors was reduced from （45.0±5.0） min in the early stage to （22.0±3.0） rain in the advanced stage. The anhepatic phase was reduced from （28.5±5.0） min to （11.8±3.1） min. The operation time of the recipients was reduced from （76.1±7.0） min to （47.7±2.9） min. The postoperative 1-, 5-d survival rate in the early-, middle- and advanced-stage was respectively 25%（10/40）, 80%（32/40）, 97%（68/70） and 5%（2/40）, 45%（18/40）, 83%（58/70）. In the early-stage, the failure of the LT mainly resulted from long anhepatic phase, failure of portal vein （PV）-infrahepatic inferior vena cava （IHVC） anastomosis and excessive intraoperative hemorrhage. A majority of the recipients failed to complete the surgery or died at postoperative 2-4 h. During the middle- and advanced-stage, the failure of LT resulted from failed PV-IHVC anastomosis. Conclusions Modified MCA can rapidly anastomose the SHVC, enhance the success rate of LT, lower the difficulty and cycle of exercise for beginners and establish an ideal LT model.
出处
《中华肝脏外科手术学电子杂志》
CAS
2017年第5期410-414,共5页
Chinese Journal of Hepatic Surgery(Electronic Edition)
基金
国家自然科学基金(81470896)
关键词
肝移植
大鼠
磁压榨吻合
移植模型
Liver Wansplantation
Rats
Magnetic compression anastomosis
Transplantation model
