摘要
目的探讨肝移植术中大血管重建方法的改进,提高吻合速度,缩短无肝期时间,减少其对机体的损害。方法选用杂种犬32只,随机分为供、受体两组,每组16只,再将受体组按血管重建方式不同随机分为两组A组10只（磁环吻合非转流组,使用不同口径的氧化钛涂层磁环）,B组6只（手工吻合被动静脉转流）。对术中各组的手术时间、血液动力学、血管吻合情况及术后存活情况分别进行观察。结果1手术时间A组手术时间为3.24±0.49h,无肝期为5.89±2.27min,肝下下腔静脉吻合时间为3.89±0.73min;B组手术时间为4.12±0.51h,无肝期为28.33±6.04min,肝下下腔静脉吻合时间12.16±3.72min;两组比较有统计学差异（P〈0.01）。2血流动力学A组血流动力学稳定,不用升压药,补液730.56±150.56ml;B组无肝期血压偏低,持续时间长,肝脏复流后需要大量升压药维持血压,补液量2241.67±390.78ml。3血管吻合口情况A组吻合口均无渗血,少数扭曲吻合口通过轻度旋转磁环予以纠正,术后无血栓形成;B组有4只因肝素化导致吻合口持续渗血,其中1只门静脉血栓,1只门静脉扭曲。4术后存活情况A组存活7d以上3只,3-6d6只,12h1只;B组存活3-6d2只,1-2d3只,12h1只。结论使用磁环进行犬肝移植大血管重建,吻合过程简便,无肝期明显缩短。但磁环需要留置腹腔内,有待进一步改进。
Objective To investigate an improved large vascular reconstruction method in the canine liver transplantation and see whether it can shorten the anheptic time and thus reduce the harmful effects during the anhepatic phase. Methods Thirty-two mongrel dogs were enrolled and divided into two groups randomly：the donor group （n= 16） and the acceptor group （n= 16）. The dogs in the acceptor group were divided into two groups, according to the different reconstruction methods ： Group A using the magnetic rings for a large vein reconstruction in the canine liver transplantation （n= 10）, and Group B using a hand-sewing large vein reconstruction in the canine liver transplantation （n = 6）. The operation time, hemodymics change, anastomosis site, and survival were observed. Results The operation time was as follows ： In Group A, the total operation time, the inferior vena cava anastomosis time, and the anheptic phase time were significantly shorter than those in Group B （3. 24±0. 49 h vs 4. 12±0. 51 h,5.89±2. 27 min vs 28. 33±6.04 min,3.89±0.73 min vs 12. 16±3. 72 min） ,with a significant difference between the two groups （P〈 0.01）. The haemodymics changes were as follows： In Group A, MAP dropped during the anhepatic phase, but it soon recovered after reperfusion,and there was only 730. 56±150. 56 ml of fluid including the donor blood that needed to be transfused, with no pressor agent required. In Group B, blood pressure dropped during the anhepatic phase, but it slowly recovered,and there was 2241.67 ± 390. 78 ml of fluid. In Group A, all the stomas had no errhysis, twist or thrombus. The twisted stomas could be corrected by the revolving of the magnetic rings. The endangium at the site of anastomosis was smooth. In Group B, most of the stomas had errthysis. In Group A, 3 dogs survived for more than 7 days, 6 dogs survived for 3-6 days, and 1 dog survived for only 12 hours. In Group B, 2 dogs survived for 3-6 days, 3 dogs survived for 1-2 days, and 1 dog survived for only 12 hours. Conclusion Using the magnetic rings for a large vascular reconstruction in the canine liver transplantation is an improved method, which can simplify the anastomosis procedures and significantly shorten the anheptic phase time. However, the magnetic rings have to be placed in the abdomen, so this method remains to be further improved.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2007年第4期420-423,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
肝移植
血管吻合
磁环
犬
Liver transplantation Vascular anastomosis Magnetic ring Dog
