• 1.廣西醫(yī)科大學第一附屬醫(yī)院肝膽外科(廣西南寧 530021);;
  • 2.廣西醫(yī)科大學第一附屬醫(yī)院超聲診斷科(廣西南寧 530021);

目的  通過建立不同體積供肝的大鼠肝移植模型,探索邊緣性體積供肝大小的適宜范圍,為研究小肝綜合征的發(fā)病機理及防治措施提供一種易于復制的小動物模型。
方法  將192只大鼠隨機分為全肝移植組、半肝移植組、小體積供肝移植組及超小體積供肝移植組,每組48只,分別建立全肝、半肝、小體積供肝和超小體積供肝的大鼠肝移植模型。移植術后,4組各抽取24只大鼠用于觀察存活率;抽取12只大鼠于移植術前,移植術后5、15、30、45及60min測定門靜脈壓力;另12只大鼠于術后24h測定谷丙轉氨酶(ALT)水平。
結果  全肝移植組的7d累積生存率為100% (24/24),半肝移植組為87.5% (21/24),小體積供肝移植組為37.5%(9/24),超小體積供肝移植組均于術后48h內死亡。全肝移植組術中開放門靜脈后,60min內其門靜脈壓力穩(wěn)定;半肝移植組大鼠在開放門靜脈后,其門脈壓力雖有小幅升高,但仍保持相對穩(wěn)定;而小體積供肝移植組和超小體積供肝移植組開放門靜脈后,其門靜脈壓力均顯著升高,15min時均達到高峰,之后該2組的門靜脈壓力開始回落,至45~60min時逐漸穩(wěn)定。供肝的體積大小與開放門靜脈后5 (r=-0.942)、15 (r=-0.947)、30 (r=-0.900)、45 (r=-0.825)和60min (r=-0.705)時的門靜脈壓力均呈負相關關系(P<0.001)。肝移植術后24 h,全肝移植組和半肝移植組ALT水平均低于小體積供肝移植組及超小體積供肝移植組(P<0.05),且小體積供肝移植組ALT水平低于超小體積供肝移植組(P<0.05)。供肝體積的大小與大鼠移植術后的ALT水平呈負相關關系(r=-0.685,
P<0.001)。
結論  大鼠部分肝移植模型中,供肝與受體標準肝臟體積比(GV/SLV)的安全界限為50%,GV/SLV為30%~35%的供肝可視為邊緣性體積供肝,小于30%的供肝可視為超小體積供肝。

引用本文: 盧景寧,彭民浩,楊紅,肖開銀,陳濱. 大鼠邊緣性體積供肝肝移植模型的實驗研究△. 中國普外基礎與臨床雜志, 2013, 20(12): 1352-1357. doi: 復制

1. Miyagi S, Kawagishi N, Fujimori K, et al. Risks of donation and quality of donors’ life after living donor liver transplantation[J]. Transpl Int, 2005, 18(1):47-51.
2. Ghobrial RM, Freise CE, Trotter JF, et al. Donor morbidity after living donation for liver transplantation[J]. Gastroenterology,2008, 135(2):468-476.
3. Kousoulas L, Becker T, Richter N, et al. Living donor liver transplantation:effect of the type of liver graft donation on donor mortality and morbidity[J]. Transpl Int, 2011, 24(3):251-258.
4. Campos BD, Botha JF. Strategies to optimize donor safety with smaller grafts for adult-to-adult living donor liver transplantation[J]. Curr Opin Organ Transplant, 2012, 17(3):230-234.
5. Lei JY, Wang WT, Yan LN. Risk factors of SFSS in adult-to-adultliving donor liver transplantation using the right liver:a single-center analysis of 217 cases[J]. Hepatogastroenterology, 2012, 59 (117):1491-1497.
6. Yagi S, Uemoto S. Small-for-size syndrome in living donor liver transplantation[J]. Hepatobiliary Pancreat Dis Int, 2012, 11(6):570-576.
7. 陸森, 錢建民, 黃海清, 等. 幾種不同預測大鼠肝臟體積(重量)方法的比較[J]. 中華實驗外科雜志, 2002, 19(3):252-253.
8. Kamada N, Calne RY. Orthotopic liver transplantation in the rat. Technique using cuff for portal vein anastomosis and biliary drainage[J]. Transplantation, 1979, 28(1):47-50.
9. Kobayashi E, Kamada N, Goto S, et al. Protocol for the techniqueof orthotopic liver transplantation in the rat[J]. Microsurgery, 1993, 14(8):541-546.
10. 盧景寧, 彭民浩, 楊定華. 直視下建立大鼠全血供原位肝移植模型[J]. 廣西醫(yī)科大學學報, 2007, 24(4):548-549.
11. 沈浩元, 王煒, 劉猛, 等. 改良單人操作大鼠原位肝移植模型的建立[J]. 中國普外基礎與臨床雜志, 2011, 18(8):825-828.
12. Selvaggi G, Tzakis A. Surgical considerations in liver transplantation:small for size syndrome[J]. Panminerva Med, 2009, 51(4):227-233.
13. Gonzalez HD, Liu ZW, Cashman S, et al. Small for size syndromefollowing living donor and split liver transplantation[J]. World J Gastrointest Surg, 2010, 2(12):389-394.
14. Gruttadauria S, Pagano D, Luca A, et al. Small-for-size syndromein adult-to-adult living-related liver transplantation[J]. World J Gastroenterol, 2010, 16(40):5011-5015.
15. Chen Z, Yan L, Li B, et al. Prevent small-for-size syndrome using dual grafts in living donor liver transplantation[J]. J Surg Res, 2009, 155(2):261-267.
16. Liu C, Lee RC, Loong CC, et al. Increasing donor body weight to prevent small-for-size syndrome in living donor liver transplantation[J]. World J Surg, 2010, 34(10):2401-2408.
17. Oniscu GC, Wigmore SJ. Increasing donor body weight to prevent small-for-size syndrome in living donor liver transplantation[J]. World J Surg, 2010, 34(10):2409-2410.
18. Tamura S, Sugawara Y, Kokudo N. Should we promote “incre-asing donor body weight to prevent small-for-size syndrome in living donor liver transplantation”?[J]. World J Surg, 2011, 35(10):2356-2357.
19. Attia M, Silva MA, Mirza DF. The marginal liver donor—an update[J]. Transpl Int, 2008, 21(8):713-724.
20. 藍翔, 李波, 王小飛, 等. 活體肝移植中非標準供肝的可用性分析[J]. 中華肝臟病雜志, 2009, 17(2):124-127.
21. Kiuchi T, Kasahara M, Uryuhara K, et al. Impact of graft size mismatching on graft prognosis in liver transplantation from living donors[J]. Transplantation, 1999, 67(2):321-327.
22. Lo CM, Fan ST, Liu CL, et al. Minimum graft size for successfulliving donor liver transplantation[J]. Transplantation, 1999, 68(8):1112-1116.
23. Lee SG. Living-donor liver transplantation in adults[J]. Br Med Bull, 2010, 94:33-48.
24. Man K, Lo CM, Ng IO, et al. Liver transplantation in rats using small-for-size grafts:a study of hemodynamic and morphological changes[J]. Arch Surg, 2001, 136(3):280-285.
25. Li J, Liang L, Ma T, et al. Sinusoidal microcirculatory changes after small-for-size liver transplantation in rats[J].Transpl Int, 2010, 23(9):924-933.
  1. 1. Miyagi S, Kawagishi N, Fujimori K, et al. Risks of donation and quality of donors’ life after living donor liver transplantation[J]. Transpl Int, 2005, 18(1):47-51.
  2. 2. Ghobrial RM, Freise CE, Trotter JF, et al. Donor morbidity after living donation for liver transplantation[J]. Gastroenterology,2008, 135(2):468-476.
  3. 3. Kousoulas L, Becker T, Richter N, et al. Living donor liver transplantation:effect of the type of liver graft donation on donor mortality and morbidity[J]. Transpl Int, 2011, 24(3):251-258.
  4. 4. Campos BD, Botha JF. Strategies to optimize donor safety with smaller grafts for adult-to-adult living donor liver transplantation[J]. Curr Opin Organ Transplant, 2012, 17(3):230-234.
  5. 5. Lei JY, Wang WT, Yan LN. Risk factors of SFSS in adult-to-adultliving donor liver transplantation using the right liver:a single-center analysis of 217 cases[J]. Hepatogastroenterology, 2012, 59 (117):1491-1497.
  6. 6. Yagi S, Uemoto S. Small-for-size syndrome in living donor liver transplantation[J]. Hepatobiliary Pancreat Dis Int, 2012, 11(6):570-576.
  7. 7. 陸森, 錢建民, 黃海清, 等. 幾種不同預測大鼠肝臟體積(重量)方法的比較[J]. 中華實驗外科雜志, 2002, 19(3):252-253.
  8. 8. Kamada N, Calne RY. Orthotopic liver transplantation in the rat. Technique using cuff for portal vein anastomosis and biliary drainage[J]. Transplantation, 1979, 28(1):47-50.
  9. 9. Kobayashi E, Kamada N, Goto S, et al. Protocol for the techniqueof orthotopic liver transplantation in the rat[J]. Microsurgery, 1993, 14(8):541-546.
  10. 10. 盧景寧, 彭民浩, 楊定華. 直視下建立大鼠全血供原位肝移植模型[J]. 廣西醫(yī)科大學學報, 2007, 24(4):548-549.
  11. 11. 沈浩元, 王煒, 劉猛, 等. 改良單人操作大鼠原位肝移植模型的建立[J]. 中國普外基礎與臨床雜志, 2011, 18(8):825-828.
  12. 12. Selvaggi G, Tzakis A. Surgical considerations in liver transplantation:small for size syndrome[J]. Panminerva Med, 2009, 51(4):227-233.
  13. 13. Gonzalez HD, Liu ZW, Cashman S, et al. Small for size syndromefollowing living donor and split liver transplantation[J]. World J Gastrointest Surg, 2010, 2(12):389-394.
  14. 14. Gruttadauria S, Pagano D, Luca A, et al. Small-for-size syndromein adult-to-adult living-related liver transplantation[J]. World J Gastroenterol, 2010, 16(40):5011-5015.
  15. 15. Chen Z, Yan L, Li B, et al. Prevent small-for-size syndrome using dual grafts in living donor liver transplantation[J]. J Surg Res, 2009, 155(2):261-267.
  16. 16. Liu C, Lee RC, Loong CC, et al. Increasing donor body weight to prevent small-for-size syndrome in living donor liver transplantation[J]. World J Surg, 2010, 34(10):2401-2408.
  17. 17. Oniscu GC, Wigmore SJ. Increasing donor body weight to prevent small-for-size syndrome in living donor liver transplantation[J]. World J Surg, 2010, 34(10):2409-2410.
  18. 18. Tamura S, Sugawara Y, Kokudo N. Should we promote “incre-asing donor body weight to prevent small-for-size syndrome in living donor liver transplantation”?[J]. World J Surg, 2011, 35(10):2356-2357.
  19. 19. Attia M, Silva MA, Mirza DF. The marginal liver donor—an update[J]. Transpl Int, 2008, 21(8):713-724.
  20. 20. 藍翔, 李波, 王小飛, 等. 活體肝移植中非標準供肝的可用性分析[J]. 中華肝臟病雜志, 2009, 17(2):124-127.
  21. 21. Kiuchi T, Kasahara M, Uryuhara K, et al. Impact of graft size mismatching on graft prognosis in liver transplantation from living donors[J]. Transplantation, 1999, 67(2):321-327.
  22. 22. Lo CM, Fan ST, Liu CL, et al. Minimum graft size for successfulliving donor liver transplantation[J]. Transplantation, 1999, 68(8):1112-1116.
  23. 23. Lee SG. Living-donor liver transplantation in adults[J]. Br Med Bull, 2010, 94:33-48.
  24. 24. Man K, Lo CM, Ng IO, et al. Liver transplantation in rats using small-for-size grafts:a study of hemodynamic and morphological changes[J]. Arch Surg, 2001, 136(3):280-285.
  25. 25. Li J, Liang L, Ma T, et al. Sinusoidal microcirculatory changes after small-for-size liver transplantation in rats[J].Transpl Int, 2010, 23(9):924-933.