Delriviere L, Kamada N, Goto S, Kobayashi E
Department of Surgery, University of Queensland, Q.I.M.R. Bancroft Center, Brisbane, Australia.
Microsurgery. 1993;14(6):416-9. doi: 10.1002/micr.1920140613.
A successful technique of liver retransplantation in the rat is described. Heterotopic nonauxiliary liver engraftment of a whole liver using cuffed anastomoses is the primary transplant procedure. The graft is implanted in the right hypochondrium and is revascularized by a portal end-to-end anastomosis. Venous drainage is via an end-to-side anastomosis between the donor infrahepatic vena cava and recipient right renal vein. The graft suprahepatic vena cava is ligated. Biliary drainage is achieved by a double stent anastomosis of the biliary ducts. Total parenchymectomy of the recipient's liver is completed leaving intact the intrahepatic and suprahepatic vena cava. Retransplantation in the orthotopic position can thus be attempted, after removal of the first graft, by cuffed anastomoses between the donor and recipient portal veins, infrahepatic vena cava and a double stent anastomosis of the common bile ducts. Anastomosis between the donor and recipient suprahepatic vena cava is completed with a 7/0 Prolene running suture. In the first group of operations (n = 6), a three week survival rate of 50% after retransplantation was obtained. Using the technical lessons of these preliminary cases, 80% of the second group of operations (n = 5), were successful in the long term. Utilization of this new technique may allow further investigations in different fields of research dealing with liver surgery and transplantation.
本文描述了一种在大鼠身上成功进行肝脏再次移植的技术。采用带套囊吻合术进行全肝异位非辅助性肝移植是主要的移植手术。将移植物植入右季肋区，通过门静脉端端吻合实现血管重建。静脉引流通过供体肝下腔静脉与受体右肾静脉之间的端侧吻合完成。移植物肝上腔静脉予以结扎。通过胆管双支架吻合实现胆汁引流。完成受体肝脏的全实质切除术，保留肝内和肝上腔静脉完整。因此，在移除第一个移植物后，可以尝试通过供体与受体门静脉、肝下腔静脉之间的带套囊吻合以及胆总管双支架吻合，在原位进行再次移植。供体与受体肝上腔静脉之间的吻合用7/0普理灵连续缝合完成。在第一组手术（n = 6）中，再次移植后的三周生存率为50%。借鉴这些初步病例的技术经验，第二组手术（n = 5）中有80%获得了长期成功。这项新技术的应用可能有助于在肝脏手术和移植的不同研究领域开展进一步的研究。
