王洪东^1,,
葛新兰²,
潘可²,
李崇辉^2,,
1. 大连医科大学附属第二医院 肝胆胰外二科, 辽宁 大连 116023
2. 解放军总医院 肝胆外科研究所, 北京 100853

详细信息 作者简介: 王洪东(1982-), 男, 主治医师。E-mail: dhdwang@163.com




通讯作者: 李崇辉, 研究员。E-mail: Lich_plagh@163.com 中图分类号: R617


摘要:目的评价新的肝上下腔静脉显微缝合方法、新的袖套和支架制作技术。方法将186只SD大鼠分为4组，前3组予肝移植，每组60只，供、受体各30只；第4组为假手术对照6只。肝移植第1组和第2组采用新的肝上下腔静脉缝合方法+新的单槽袖套，其中第1组采用新的无损胆道支架，第2组采用传统的粗制支架。第3组采用传统的双定点肝上下腔静脉缝合方法+传统的多痕袖套+无损支架。第4组为开腹后仅游离肝周韧带的假手术组。记录肝上下腔静脉、门静脉和肝下下腔静脉的重建时长和无肝期时长，1周和1个月生存率。测定术后1个月肝功能，并明确有无血管扭转、血栓形成和胆汁瘤、胆道梗阻等并发症。结果第1组肝上下腔静脉显微缝合时间为（661±69）s、第2组（662±67）s，第3组（826±73）s，第1组、第2组均较第3组快，差异有统计学意义（P < 0.05）。第1组肝下下腔静脉重建时间为（61±12）s，第2组（58±10）s，第3组（72±12）s；第1组门静脉重建时间为（73±11）s、第2组（76±10）s，第3组（91±17）s；第1组、第2组均较第3组快，差异有统计学意义（P < 0.05）。第1组无肝期（758±68）s，第2组（760±67）s，第3组（939±73）s，第1组、第2组均短于第3组，差异有统计学意义（P < 0.05）。第1组、第3组的胆道并发症发生率低于第2组。第1组、第3组的1周、1个月生存率均高于第2组。结论新的肝上下腔静脉显微缝合方法结合单槽袖套的重建时间短、显著缩短无肝期。无损胆道支架术后并发症更少。
关键词: 大鼠肝移植/
显微外科/
静脉和胆管重建


Abstract:ObjectiveIn this study, a new microsuture technique was used for anastomosis of the superior hepatic vena cava (SHVC). And a special single groove cuff and blade-cut stent were introduced. With these modified techniques, we aimed to make a faster anastomosis of the veins and to provide a better stent for the bile duct.MethodsAccording to different microsuture techniques for the SHVC and different types of cuffs and stents, three rat orthotopic liver transplantation (ROLT) groups were created to compare the operation times and prognoses. Sham operations were performed as controls in the fourth group. The time expenditures with each step were compared among the transplantation groups. Biochemical parameters were tested at the end of a 1-month observation period. The short and long-term survival rates of the transplantation groups were recorded and compared.ResultsOur new microsuture technique was faster than the conventional continuous suture technique for SHVC anastomosis [(New (661±69)s, (662±67)s vs Tradition (826±73)s, P < 0.05]. The use of a single-groove cuff for the reconstruction of the portal vein and the IHVC (infrahepatic vena cava) shortened the anastomotic time [IHVC: New (61±12)s, (58±10)s vs Tradition (72±12)s, P < 0.05;PV: New (73±11)s, (76±10)s vs Tradition (91±17)s, P < 0.05]. The use of blade-cut stents resulted in fewer biliary complications and better survival over the short and long terms [New (758±68)s, (760±67)s vs Tradition(939±73)s, P < 0.05].ConclusionOur new microsuture technique and the single-groove cuffs are proved to be precise methods for venous reconstruction which shorten the anhepatic time and anastomotic time significantly. The blade-cut stents reduce the incidence of biliary complications.
Keywords:liver transplantation/
rats/
microsurgery

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