Higashiyama H, Sasaki H, Kumada K, Egawa H, Yamamoto N, Takeuchi T, Konishi Y, Yamaguchi M, Okamoto R, Yamaguchi T
Second Department of Surgery, Faculty of Medicine, Kyoto University, Japan.
Eur Surg Res. 1991;23(3-4):185-94. doi: 10.1159/000129151.
We performed 22 canine orthotopic partial liver transplantations (PLTs) with three different revascularization methods; portal vein arterialization (PVA group, n = 11), hepatic arterial shunt (HAS group, n = 5), and conventional portal vein reperfusion (control group, n = 6). Our purpose was to evaluate the feasibility of PVA as a revascularization technique in PLT assessing the changes in arterial ketone body ratio (KBR) as an index of hepatic energy status. After the first anastomosis (left hepatic vein), the ischemic partial liver graft was revascularized with arterial blood flow shunted from the external iliac artery to the hepatic side of the portal vein (PVA group) or the proper hepatic artery (HAS group). Both anhepatic period and ischemia time were significantly shortened in groups PVA and HAS as compared with those in control. In the PVA group, 10 out of 11 recipients survived for at least 5 days (14.2 +/- 3.8 days, mean +/- SEM), while 3 out of 5 (5.2 +/- 1.0) survived in the HAS group and 4 out of 6 (6.2 +/- 1.3) in the controls. Although portal blood flow during PVA was only about 25% of the total hepatic blood flow at preclamping, the KBR was rapidly restored after PVA and showed almost the same values at preclamping. The KBR values during the arterialization time and initial velocity of KBR recovery in the PVA group were significantly higher than those in the HAS and control groups. These results suggest that PVA presents an attractive option in PLT.
我们采用三种不同的血管重建方法进行了22例犬原位部分肝移植（PLT）；门静脉动脉化（PVA组，n = 11）、肝动脉分流（HAS组，n = 5）和传统门静脉再灌注（对照组，n = 6）。我们的目的是评估PVA作为PLT血管重建技术的可行性，评估动脉酮体比（KBR）的变化作为肝脏能量状态的指标。在完成首次吻合（左肝静脉）后，缺血的部分肝移植物通过从髂外动脉分流至门静脉肝侧（PVA组）或肝固有动脉（HAS组）的动脉血流进行血管重建。与对照组相比，PVA组和HAS组的无肝期和缺血时间均显著缩短。在PVA组中，11只受体中有10只存活至少5天（平均±标准误为14.2±3.8天），而HAS组5只中有3只（5.2±1.0）存活，对照组6只中有4只（6.2±1.3）存活。尽管PVA期间门静脉血流仅约为夹闭前门静脉总血流的25%，但PVA后门静脉血流迅速恢复，且显示出与夹闭前几乎相同的值。PVA组动脉化期间的KBR值和KBR恢复的初始速度显著高于HAS组和对照组。这些结果表明，PVA在PLT中是一个有吸引力的选择。
