Xue Lijun, Lu Yin, Qiu Weihua, Zhou Huijiang, Zhang Guiyang, Jin Zhiming, Lin Moubin, Chen Huimin, Rui Zhang, Zheng Yunjiang
Department of Surgery, Center of Organ Transplantation, Rui Jin Hospital, Affiliation of Medical College of Shanghai, JiaoTong University, Shanghai, China.
Am J Surg. 2009 Jul;198(1):110-21. doi: 10.1016/j.amjsurg.2008.07.057. Epub 2009 Feb 13.
Establishment of an instant, reproducible, and reliable rat model of a refined 3-cuff technique for performing orthotopic intestinal transplantation is reported, and the surgical skills required to perform modified surgical procedure are discussed.
A retrospective analysis was used to study 270 rat cases subject to orthotopic intestinal transplantation (OIT) performed in our transplantation center from March 2006 to March 2008. After establishing the portal vein cuff method, a conventional hand-sewn anastomosis method combination, with porto-to-portal re-establishment by cuffed anastomosis technique, was used in group 1 (n = 140), and the modified 3-cuff anastomosis method was applied in group 2 (n = 130). Statistical comparison was made between the 2 groups.
In group 1, 97 of 140 (69.3%) recipients survived >7 days, and 69 (49.3%) survived >30 days, whereas in group 2, respective survival was 110 of 130 (84.6%) and 86 of 130 (66.2%). Average cold ischemic times in the 2 groups were 48.5 +/- 5.1 minutes and 31 +/- 3.0 minutes, respectively. There was a significant difference between the 2 groups (P <.05). In most cases, the average volume of bleeding during recipient surgery was <1 mL using the simplified 3-cuff anastomosis technique. There was shorter graft revascularization time with the new model of sutureless microanastomosis using cuff apparatus for OIT in rats compared with the control group. The method adopted in group 2 was much easier, more stable, and more feasible than that in group 1. Sixty-three rats died in 7 days, and autopsy verified the causative factors leading to death, which are summarized in the text. The results obtained were acceptable and satisfactory. Overall, there was a comparative lower incidence of complications associated with the procedure used in group 2.
The modified 3-cuff anastomosis technique for rat OIT models has several obvious advantages, which can be summarized as follows: vascular anastomosis is stable and simplified, and blood loss is significantly decreased; natural anatomic physiologic portal graft drainage is maintained; and intraoperative mortality and postsurgical morbidity are minimized. Furthermore, technical refinement of rat OIT models established by our research team can be carried out without a microscope and can be easily implemented in the laboratory by 1 trainee with acceptable success after a short period of training. We regard it as one of the best available orthotopic small-bowel transplantation methods in rat.
报道了一种用于原位肠道移植的改良三袖套技术的快速、可重复且可靠的大鼠模型的建立，并讨论了实施改良手术操作所需的手术技巧。
采用回顾性分析方法，研究2006年3月至2008年3月在我们移植中心进行原位肠道移植（OIT）的270例大鼠病例。在建立门静脉袖套法后，第1组（n = 140）采用传统手工缝合吻合方法组合，通过袖套吻合技术进行门静脉对门静脉重建，第2组（n = 130）应用改良三袖套吻合方法。对两组进行统计学比较。
在第1组中，140只受体中有97只（69.3%）存活超过7天，69只（49.3%）存活超过30天，而在第2组中，相应的存活率分别为130只中的110只（84.6%）和130只中的86只（66.2%）。两组的平均冷缺血时间分别为48.5±5.1分钟和31±3.0分钟。两组之间存在显著差异（P <.05）。在大多数情况下，使用简化三袖套吻合技术，受体手术期间的平均出血量<1 mL。与对照组相比，大鼠原位肠道移植使用袖套装置的无缝合微吻合新模型的移植物再灌注时间更短。第2组采用的方法比第1组更容易、更稳定且更可行。63只大鼠在7天内死亡，尸检证实了导致死亡的原因，这些原因在文中进行了总结。获得的结果是可以接受且令人满意的。总体而言，第2组所采用的手术相关并发症发生率相对较低。
大鼠原位肠道移植模型的改良三袖套吻合技术具有几个明显优点，可总结如下：血管吻合稳定且简化，失血量显著减少；维持了自然解剖生理门静脉移植物引流；术中死亡率和术后发病率降至最低。此外，我们研究团队建立的大鼠原位肠道移植模型的技术改良无需显微镜即可进行，经过短期培训后，1名实习生可在实验室轻松实施并取得可接受的成功率。我们认为它是大鼠原位小肠移植的最佳可用方法之一。
