Howanietz L F
Wien Klin Wochenschr Suppl. 1975;44:1-13.
Experimental orthotopic livertransplantation is a very difficult procedure (Largiadér). This is due to the difficult specific anatomy of the liver, the high sensibility of the liver against anoxia and the distrubance of blood coagulation during transplantation. This investigation demonstrates that ischemia does not only damage the livercells, but also the bile ducts. We could show that these changes on the bile ducts are responsible for a certain number of unsuccessfull results of livertransplantations. In basic experiments we could demonstrate that ischemia is the cause of bile duct changes. There is always a critical situation for the common bile duct, when we tie the hepatic artery and dissect simultaneously the common bile duct. To keep this changes to a minimum we pay attention to the following points: 1. Correct perfusion and cooling of the livertransplant. 2. Fast recirculation of the hepatic artery before performing portal anastomosis. 3. The dissection of the common bile duct near the duodenum to preserve collaterale vessels from the proprial hepatic artery considering the specific anatomy.
实验性原位肝移植是一个非常困难的手术(拉吉亚德)。这是由于肝脏特殊的解剖结构、肝脏对缺氧的高度敏感性以及移植过程中凝血功能的紊乱。本研究表明,缺血不仅会损害肝细胞,还会损害胆管。我们可以证明,胆管的这些变化是导致一定数量肝移植手术失败的原因。在基础实验中,我们可以证明缺血是胆管变化的原因。当我们结扎肝动脉并同时解剖胆总管时,胆总管总会出现危急情况。为了将这种变化降至最低,我们注意以下几点:1. 正确灌注和冷却肝移植器官。2. 在进行门静脉吻合之前,使肝动脉快速再循环。3. 考虑到特定的解剖结构,在十二指肠附近解剖胆总管,以保留来自肝固有动脉的侧支血管。