中国普外基础与临床杂志

中国普外基础与临床杂志

大鼠 DCD 供肝原位肝移植术后早期死亡的原因分析

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目的 建立稳定的心脏死亡器官捐献(donation after cardiac death,DCD)供肝大鼠原位肝移植动物模型,分析移植后 24 h 内大鼠死亡原因并探索相应的改进措施。 方法 所有供肝获取前经历供体心脏停跳 10 min,采用改良 Kamada 的“二袖套”吻合法完成大鼠 DCD 供肝原位肝移植手术 100 例,记录各个手术阶段所用时间及术后大鼠的死亡情况。 结果 在 40 d 内完成大鼠 DCD 供肝原位肝移植手术 100 例,供体手术时间(20±5)min,受体手术时间(55±5)min,无肝期(20±3)min。大鼠术后受体一般情况可。术中死亡 9 例,其中术中大出血 4 例、麻醉意外 1 例、手术时间过长 1 例、套管植入失败 1 例、空气栓塞 2 例。术后 12 h 内死亡 21 例,其中术后肠道坏死 6 例、术后吻合口渗血 6 例、术后肺水肿 3 例、术中失血过多 4 例、术后血管栓塞 2 例,不明原因死亡 1 例;12~24 h 死亡 16 例,其中术后肠道坏死 9 例、术后吻合口渗血 3 例、术后肺水肿 2 例、术中失血过多 1 例、术后血管栓塞 1 例,不明原因死亡 3 例。 结论 导致大鼠 DCD 供肝肝移植术后早期死亡的原因很多,其中术后肠道坏死、术中及术后出血、术后肺水肿及术后血管栓塞是主要的致死因素。针对术后死亡原因采取相应的预防及改进措施能大大提高大鼠术后存活率,从而建立稳定的大鼠 DCD 供肝原位肝移植动物模型。

Objective To establish a stable model of orthotopic liver transplantation (OLT) using donation after cardiac death (DCD) in rat, and to analyze death causes within 24 h after OLT, then explore appropriate treatment strategies for it. Method The heart arrested 10 min before liver graft harvesting. The rat OLT model using DCD was performed by Kamada two-cuff technique. The operation time and death were recorded. Results One hundred OLT models using DCD were performed successfully within 40 d, the donor operation time was (20±5) min, the recepient operation time was (55±5) min, the anhepatic phase was (20±3) min. Nine cases were died during operation, including 4 cases of massive haemorrhage, 1 case of anesthesia accident, 1 case of longer operation time, 1 case of sleeve implant failure, and 2 cases of aeroembolism. Twenty-one cases died within 12 h operation, including 6 cases of intestinal necrosis, 6 cases of anastomotic bleeding, 3 cases of pulmonary edema, 4 cases of massive haemorrhage, 2 cases of vascular embolism, 1 case of unexplained death. Sixteen rats died during 12–24 h after operation, including 9 cases of intestinal necrosis, 3 cases of anastomotic bleeding, 2 cases of pulmonary edema, 1 case of massive haemorrhage, 1 case of vascular embolism, 3 cases of unexplained death. Conclusions There are many reasons resulting in early death of rat OLT using DCD, postoperative intestinal necrosis, intraoperative and postoperative bleeding, and postoperative pulmonary edema are main causes. For these reasons, prevention and improvement measures are helpful to establish a stable model and improve successful rate of rat OLT using DCD.

关键词: 大鼠; 心脏死亡器官捐献; 肝移植; 死亡原因

Key words: rat; donation after cardiac death; orthotopic liver transplantation; death cause

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