沈浩元 1,2 , 王煒 1 , 劉猛 1 , 李豐 1 , 姜開文 1
  • 1.廣州醫(yī)學(xué)院第一附屬醫(yī)院肝膽外科（廣東廣州 510120）;;
  • 2.湖北省孝感市中心醫(yī)院普通外科（湖北孝感 432100）;

目的探索改良傳統(tǒng)手術(shù)方法單人操作大鼠原位肝移植模型的建立方法。方法200只（100對）大鼠建立原位肝移植模型，其中80只（40對）進行正式實驗，采用改良的Kamada二袖套法，再對手術(shù)中關(guān)鍵步驟進行改良，并對術(shù)中及術(shù)后恢復(fù)情況進行分析。結(jié)果本組80只大鼠原位肝移植手術(shù)均順利完成。供體手術(shù)時間為(28.5±2.4) min，供肝修整時間為(10.2±1.8) min; 肝上下腔靜脈吻合時間為(15.3±1.9) min，門靜脈吻合時間為(3.4±1.2) min，受體無肝期為(23.8±1.9) min，肝下下腔靜脈吻合時間為(5.1±2.1) min，膽道重建時間為(3.1±0.9) min。 整個手術(shù)過程中供、受體出血量均不足0.5 ml。40只受體大鼠，術(shù)后2 d成活率為90.0%（36/40），3只死于肝上下腔靜脈縫合處出血，1只死于無肝期過長; 術(shù)后7 d成活率為82.5%（33/40），3只均死于腹腔內(nèi)感染。 結(jié)論在單人操作建立大鼠原位肝移植模型中，通過腹主動脈和下腔靜脈整塊游離行腹主動脈灌注供肝、精細解剖左隔下靜脈三角、術(shù)中熱凝控制出血等方面的改良可減少手術(shù)并發(fā)癥的發(fā)生，保證供肝質(zhì)量，提高大鼠成活率。

引用本文： 沈浩元,王煒,劉猛,李豐,姜開文. 改良單人操作大鼠原位肝移植模型的建立. 中國普外基礎(chǔ)與臨床雜志, 2011, 18(8): 825-828. doi: 復(fù)制

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2. Wan CD, Cheng R, Wang HB, et al. Immunomodulatory effects of mesenchymal stem cells derived from adipose tissues in a rat orthotopic liver transplantation model [J]. Hepatobiliary Pancreat Dis Int, 2008, 7(1): 2933.
3. Zhu H, Marco C, Gianfranco F. Early changes of graft function, cytokines and superoxide dismutase serum levels after donor liver denervation and Kupffer cell depletion in a rattorat liver transplantation model [J]. Hepatobiliary Pancreat Dis Int, 2009, 8(2): 152156.
4. Fujiki M, Esquivel CO, Martinez OM, et al. Induced tolerance to rat liver allografts involves apoptosis of intragraft T cells and the generation of CD4+CD25+FoxP3+ T regulatory cells [J]. Liver Transpl, 2010, 16(2): 14754.
5. Qin L, Guan HG, Zhou XJ, et al. Blockade of 41BB/41BB ligand interactions prevents acute rejection in rat liver transplantation [J]. Chin Med J, 2010 (Engl), 123(2): 212215.
6. Tolboom H, Pouw RE, Izamis ML, et al. Recovery of warm ischemic rat liver grafts by normothermic extracorporeal perfusion [J]. Transplantation, 2009, 87(2): 170177.
7. Lee S, Charters AC, Chandler JG, et al. A technique for orthotopic liver transplantation in the rat [J]. Transplantation, 1973, 16(6): 664669.
8. Lee S, Charters AC 3rd, Orloff MJ. Simplified technic for orthotopic liver transplantation in the rat [J]. Am J Surg, 1975, 130(1): 3840.
9. Kamada N, Calne RY. Orthotopic liver transplantation in the rat: Technique using cuff for portal vain anastomosis and biliary drainge [J]. Transplantation, 1979, 28(1): 4750.
10. Kamada N, Calne RY. A surgical experience with five hundred thirty liver transplants in the rat [J]. Surgery, 1983, 93(1 Pt 1): 6469.
11. Matevossian E, Doll D, Hüser N, et al. Liver transplantation in the rat: singlecenter experience with technique, longterm survival, and functional and histologic findings [J]. Transplant Proc, 2009, 41(6): 26312636.
12. 李鏡鋒, 丁煥新, 白建華, 等. 無心跳供肝大鼠肝移植模型的手術(shù)操作技巧探討 [J]. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(8): 785788.
13. 劉靜, 李江, 張升寧, 等. 改良法構(gòu)建大鼠減體積肝移植模型 [J]. 中國組織工程研究與臨床康復(fù), 2010, 14(18): 32523257.
14. 黃新立, 張峰, 王學(xué)浩, 等. 建立大鼠部分肝移植動脈化模型的實驗研究 [J]. 中國普外基礎(chǔ)與臨床雜志, 2004, 11(3): 224227.
15. 彭勇, 龔建平, 劉長安, 等. 大鼠原位肝移植模型制作過程中麻醉方法的選擇 [J]. 中國普通外科雜志, 2003, 12(9): 673676.
16. 金成, 張培建, 馮敏, 等. 經(jīng)門靜脈灌注法大鼠自體原位肝移植模型的建立 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(3): 184186.
17. 張升寧, 白建華, 劉靜, 等. 大鼠原位肝移植模型的手術(shù)改進及體會 [J]. 肝膽外科雜志, 2008, 16(3): 210213.
18. 丘昶儒, 王煒, 程衛(wèi), 等. 預(yù)實驗中大鼠原位肝移植常見失敗原因及對策 [J]. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(10): 10351038.
19. 王宇, 闞和平, 蔣曉青. 雙袖套法大鼠異體原位肝移植模型改進與體會 [J]. 中國臨床解剖學(xué)雜志, 2010, 28(4): 463466.
20. Jiang Y, Qiu YD, Gu XP, et al. Rat liver transplantation without preservation of “phrenic ring” using double cuff method [J]. World J Gastroenterol, 2004, 10 (10): 15261527.
  1. 1. Kebis A, Kukan M, Grancic P, et al. A novel way of liver preservation improves rat liver viability upon reperfusion [J]. J Zhejiang Univ Sci B, 2007, 8(5): 289295.
  2. 2. Wan CD, Cheng R, Wang HB, et al. Immunomodulatory effects of mesenchymal stem cells derived from adipose tissues in a rat orthotopic liver transplantation model [J]. Hepatobiliary Pancreat Dis Int, 2008, 7(1): 2933.
  3. 3. Zhu H, Marco C, Gianfranco F. Early changes of graft function, cytokines and superoxide dismutase serum levels after donor liver denervation and Kupffer cell depletion in a rattorat liver transplantation model [J]. Hepatobiliary Pancreat Dis Int, 2009, 8(2): 152156.
  4. 4. Fujiki M, Esquivel CO, Martinez OM, et al. Induced tolerance to rat liver allografts involves apoptosis of intragraft T cells and the generation of CD4+CD25+FoxP3+ T regulatory cells [J]. Liver Transpl, 2010, 16(2): 14754.
  5. 5. Qin L, Guan HG, Zhou XJ, et al. Blockade of 41BB/41BB ligand interactions prevents acute rejection in rat liver transplantation [J]. Chin Med J, 2010 (Engl), 123(2): 212215.
  6. 6. Tolboom H, Pouw RE, Izamis ML, et al. Recovery of warm ischemic rat liver grafts by normothermic extracorporeal perfusion [J]. Transplantation, 2009, 87(2): 170177.
  7. 7. Lee S, Charters AC, Chandler JG, et al. A technique for orthotopic liver transplantation in the rat [J]. Transplantation, 1973, 16(6): 664669.
  8. 8. Lee S, Charters AC 3rd, Orloff MJ. Simplified technic for orthotopic liver transplantation in the rat [J]. Am J Surg, 1975, 130(1): 3840.
  9. 9. Kamada N, Calne RY. Orthotopic liver transplantation in the rat: Technique using cuff for portal vain anastomosis and biliary drainge [J]. Transplantation, 1979, 28(1): 4750.
  10. 10. Kamada N, Calne RY. A surgical experience with five hundred thirty liver transplants in the rat [J]. Surgery, 1983, 93(1 Pt 1): 6469.
  11. 11. Matevossian E, Doll D, Hüser N, et al. Liver transplantation in the rat: singlecenter experience with technique, longterm survival, and functional and histologic findings [J]. Transplant Proc, 2009, 41(6): 26312636.
  12. 12. 李鏡鋒, 丁煥新, 白建華, 等. 無心跳供肝大鼠肝移植模型的手術(shù)操作技巧探討 [J]. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(8): 785788.
  13. 13. 劉靜, 李江, 張升寧, 等. 改良法構(gòu)建大鼠減體積肝移植模型 [J]. 中國組織工程研究與臨床康復(fù), 2010, 14(18): 32523257.
  14. 14. 黃新立, 張峰, 王學(xué)浩, 等. 建立大鼠部分肝移植動脈化模型的實驗研究 [J]. 中國普外基礎(chǔ)與臨床雜志, 2004, 11(3): 224227.
  15. 15. 彭勇, 龔建平, 劉長安, 等. 大鼠原位肝移植模型制作過程中麻醉方法的選擇 [J]. 中國普通外科雜志, 2003, 12(9): 673676.
  16. 16. 金成, 張培建, 馮敏, 等. 經(jīng)門靜脈灌注法大鼠自體原位肝移植模型的建立 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(3): 184186.
  17. 17. 張升寧, 白建華, 劉靜, 等. 大鼠原位肝移植模型的手術(shù)改進及體會 [J]. 肝膽外科雜志, 2008, 16(3): 210213.
  18. 18. 丘昶儒, 王煒, 程衛(wèi), 等. 預(yù)實驗中大鼠原位肝移植常見失敗原因及對策 [J]. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(10): 10351038.
  19. 19. 王宇, 闞和平, 蔣曉青. 雙袖套法大鼠異體原位肝移植模型改進與體會 [J]. 中國臨床解剖學(xué)雜志, 2010, 28(4): 463466.
  20. 20. Jiang Y, Qiu YD, Gu XP, et al. Rat liver transplantation without preservation of “phrenic ring” using double cuff method [J]. World J Gastroenterol, 2004, 10 (10): 15261527.