Di Domenico Stefano, Bovio Giulio, Gelli Maximiliano, Ravazzoni Ferruccio, Andorno Enzo, Cottalasso Damiano, Valente Umberto
Department of General Surgery and Organ Transplantation, S. Martino Hospital, Genoa, Italy.
BMC Surg. 2007 Aug 16;7:18. doi: 10.1186/1471-2482-7-18.
Liver transplantation in presence of diffuse portal vein thrombosis is possible by using caval blood as portal inflow, through cavo-portal transposition. However, clinical results are heterogeneous and experimental studies are needed, but similar hemodynamic conditions are difficult to obtain, especially in small animals. Herein we describe a new simple model of cavo-portal transposition in rat.
Spontaneous porto-systemic shunts are induced by subcutaneous transposition of the spleen. The presence of porto-caval shunts through the spleen permits the interruption of the main portal vein without splanchnic hemodynamic consequences. Cavo-portal transposition is achieved by anastomosing the inferior vena cava and the main portal vein after division of the pancreatic-duodenal vein.
Selective angiography revealed total splanchnic blood diversion to the systemic venous circulation through the neoformed collaterals; macroscopical examination showed the absence of any signs of acute portal hypertension with normal liver and gut appearance.
This model of cavoportal transposition is simple, effective and it simulates the clinical hemodynamic condition since the porto-systemic shunts induced by splenic subcutaneous transposition correspond to the physiological inframesocolic collaterals during chronic portal thrombosis in man.
通过腔门静脉转位术,利用腔静脉血作为门静脉血流,在存在弥漫性门静脉血栓形成的情况下进行肝移植是可行的。然而,临床结果各异,需要进行实验研究,但难以获得相似的血流动力学条件,尤其是在小动物中。在此,我们描述一种新的大鼠腔门静脉转位简易模型。
通过脾脏皮下转位诱导自发性门体分流。经脾脏的门腔分流的存在使得在不影响内脏血流动力学的情况下中断主要门静脉成为可能。在切断胰十二指肠静脉后,通过吻合下腔静脉和主要门静脉来实现腔门静脉转位。
选择性血管造影显示,全部内脏血流通过新形成的侧支循环转向体循环静脉;宏观检查显示,肝脏和肠道外观正常,无任何急性门静脉高压迹象。
这种腔门静脉转位模型简单、有效,并且由于脾脏皮下转位诱导的门体分流与人类慢性门静脉血栓形成期间的生理性结肠系膜内侧支循环相对应,所以它模拟了临床血流动力学状况。