Lange R, Erhard J, Sander A, Kemnitz J, Garkuwa D A, Eigler F W
Abteilung für Allgemeine Chirurgie, Universitätsklinikum Essen, Germany.
Langenbecks Arch Chir. 1997;382(6):277-83. doi: 10.1007/s004230050067.
The aim of the present experimental investigation was to assess the circulatory, biochemical and histopathological consequences of complete portal vein arterialization of the transplanted liver in 'Göttinger' miniature pigs. Orthotopic liver transplantations using a passive portojugular shunt were performed in six male 'Göttinger' miniature pigs. Using an iliac artery segment interposition of the animal donor, the hepatic artery (HA) of the transplant liver was anastomized end-to-end and the portal vein (PA) also united with the internal iliac artery stump end-to-end. The central anastomosis was performed onto the suprarenal aorta. Portal vein blood was drained into the infrahepatic caval vein via an end-to-side shunt (PCS). During the course, the following parameters were determined: arterial blood pressure, venous pressure, cardiac output, electromagnetic blood flow measurements across the HA, PA, and PCS, PA mean pressure, transaminases, partial thromboplastin time and fibrinogen. Liver biopsies and autopsy specimens were investigated. One of six animals died a few hours postoperatively, two of six died after 48 and 72 h, respectively, whereas three pigs survived the scheduled 7 days. The cardiac output fell intraoperatively initially by an average of 20% but had approximately the starting volume of 2.2 l/min at the end of the operation. Although the diameter of the anastomosis was reduced to 4 mm, the flow in the arterialized PA on average was 340 ml/min when the vessel clamp was opened. At the end of operation the mean was 380 ml/min, the interval of measurement being 75 min. The flow across the PCS and the HA were constant during the course. As mechanism for this phenomenon, autoregulation of the liver blood flow on a sinusidal level has been suggested. The biochemical results and the histopathological findings showed no change compared to previous findings in a control group of animals in which liver transplantation was performed by our team. Complete arterialization of the PA is well tolerated in liver transplantation in 'Göttinger' miniature pigs with regard to circulation and liver function in a short-term trial of a maximum of 7 days. Long-term results are still to come.
本实验研究的目的是评估在“哥廷根”小型猪中，移植肝脏完全门静脉动脉化后的循环、生化和组织病理学结果。对6只雄性“哥廷根”小型猪进行了使用被动门静脉颈静脉分流的原位肝移植。利用动物供体的一段髂动脉进行插入，将移植肝脏的肝动脉（HA）端端吻合，门静脉（PA）也与髂动脉残端端端相连。中心吻合在肾上腺主动脉上进行。门静脉血通过端侧分流（PCS）引流至肝下腔静脉。在此过程中，测定了以下参数：动脉血压、静脉压力、心输出量、通过HA、PA和PCS的电磁血流测量、PA平均压力、转氨酶、部分凝血活酶时间和纤维蛋白原。对肝脏活检和尸检标本进行了研究。6只动物中有1只在术后数小时死亡，6只中有2只分别在48小时和72小时后死亡，而3只猪存活了预定的7天。心输出量术中最初平均下降20%，但在手术结束时约有起始的2.2升/分钟的量。尽管吻合口直径缩小至4毫米，但血管夹打开时，动脉化PA中的平均血流量为340毫升/分钟。手术结束时平均为380毫升/分钟，测量间隔为75分钟。在此过程中，通过PCS和HA的血流保持恒定。作为这种现象的机制，有人提出是在窦状隙水平上对肝血流进行了自动调节。与我们团队进行肝移植的动物对照组以前的结果相比，生化结果和组织病理学发现没有变化。在“哥廷根”小型猪的肝移植中，在最长7天的短期试验中，就循环和肝功能而言，PA的完全动脉化耐受性良好。长期结果仍有待观察。
