门静脉血流改道在实验性辅助部分原位肝移植中的重要性。

Importance of portal flow diversion in experimental auxiliary partial orthotopic liver transplantation.

作者信息

de Jonge J, Zondervan P E, IJzermans J N, Metselaar H J, Tilanus H W

机构信息

Department of Surgery, Erasmus University Hospital Dijkzigt, Rotterdam, The Netherlands.

出版信息

Transplantation. 2000 Jul 15;70(1):44-7.

PMID:10919573

Abstract

BACKGROUND

Auxiliary partial orthotopic liver transplantation (APOLT) has successfully been performed in patients with noncirrhotic metabolic diseases. It remains, however, unclear if intervention in the portal venous inflow is necessary to ensure adequate portal blood flow to graft and host liver. In this experimental study we evaluate the hepatic flow during APOLT.

METHODS

Left lateral/medial segmental grafts were transplanted from beagle to dalmatian dogs. Vascular structures were anastomosed end-to-end. The effect of diversion of the portal flow was studied in three groups: in the ligation group (n=3) the host portal vein was tied off, the free flow group (n=6) had random flow to both livers. In the banding group (n=11) the host portal vein was banded with a adjustable strapband to restore the pretransplantation flow distribution.

RESULTS

After reperfusion the blood flow through the common portal vein decreased from 49 to 36 ml/kg/min (P<0.03) in all animals. Flow through the left portal vein decreased from 26 to 5 ml/kg/min (P<0.0001). Banding restored the flow in the left portal vein to 12 ml/kg/min, although the flow in the free-flow group remained 4 ml/kg/min. In the ligation group the total portal flow was forced toward the graft leading to the highest perfusion: 24 ml/kg/min (P<0.005). Adverse effect of this ligation was the development of portal hypertension.

CONCLUSIONS

This experimental study confirms that diversion of the portal flow is necessary for adequate graft perfusion in APOLT. Banding can restore the pretransplantation flow distribution, without compromising the flow in the common portal vein.

摘要

背景

辅助性部分原位肝移植（APOLT）已成功应用于非肝硬化代谢性疾病患者。然而，对于门静脉血流干预是否有必要以确保移植肝和宿主肝脏获得足够的门静脉血流仍不清楚。在本实验研究中，我们评估了APOLT期间的肝血流情况。

方法

将比格犬的左外侧/内侧叶移植肝移植到斑点犬体内。血管结构进行端端吻合。在三组中研究了门静脉血流改道的效果：在结扎组（n = 3）中，宿主门静脉被结扎；自由血流组（n = 6）中，两个肝脏均有随机血流；在束带组（n = 11）中，宿主门静脉用可调节束带束扎以恢复移植前的血流分布。

结果

再灌注后，所有动物通过门静脉主干的血流从49降至36 ml/kg/min（P < 0.03）。通过左门静脉的血流从26降至5 ml/kg/min（P < 0.0001）。束带使左门静脉血流恢复至12 ml/kg/min，尽管自由血流组的血流仍为4 ml/kg/min。在结扎组中，总门静脉血流被迫流向移植肝，导致最高灌注：24 ml/kg/min（P < 0.005）。这种结扎的不良影响是门静脉高压的发生。