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辅助性异位部分肝移植治疗急性肝功能衰竭的实验研究
作者:赵伟 俞建光 
单位:东南大学医学院附属南京第二医院,江苏南京,210003
关键词:辅助性异位部分肝移植 急性肝功能衰竭 暴发性肝功能衰竭  
分类号:R657.3, R-33
出版年·卷·期(页码):2003·22·第五期(323-325)
摘要:

目的:探讨辅助性异位部分肝移植对肝功能衰竭(肝衰)的治疗作用.方法:用家猪配对开展辅助性异位部分肝移植,分两组.A组:受体肝脏保持原状,其肝动脉结扎、门静脉缩窄;供肝植入受体右肝下,仅建立门静脉血供.B组:供肝动脉和门静脉血供均建立,其它手术内容与A组相同.监测各组受体存活情况、肝功能情况、病理及供肝胆汁分泌情况.结果:B组受体3 d以上成活率显著高于A组.B组手术前后胆红素无显著改变,A组术后胆红素显著高于术前,术后第2天A组胆红素显著高于B组.B组供肝胆汁分泌良好,肝细胞存活并有活跃的代偿性增生;A组供肝无或仅有少量胆汁分泌,肝细胞大片坏死.两组受体均有术后白蛋白下降、丙氨酸氨基转移酶增高.结论:辅助性异位部分肝移植足以纠正肝衰,在临床可以用相似的方法治疗急性或暴发性肝衰患者.

Objective  To investigate the effect of auxiliary heterotopic partial liver transplantation on acute liver failure.Methods  Auxiliary heterotopic partial liver transplantation was performed in two groups of pigs.In group A,recipients’liver remained untouched,while their liver artery was ligated,portal vein narrowed;donated liver was transplanted under the recipients’ right liver,portal vein supply was constructed only.In group B,the same procedure was performed except that both portal vein supply and arterial blood supply were constructed of donated liver.The living condition,liver function,pathology and bile secretion of donated liver were observed and analysed.Results  The surviving rates of liver were higher in group B than that in group A significantly.The concentration of bilirubin did not significantly changed after operation in group B,while it dramatically increased in group A after operation,the concentrations of bilirubin in group A was significantly higher than that in group B 2 days after operation.In group B,bile secretion of donated liver was fairly good,hepatocyte of donated survived and proliferated well.In group A,the donated liver didn’t secrete bile,and hepatocyte was necrotic.Conclusion  Auxiliary heterotopic partial liver transplantation is effective to treat liver failure,it can be used in clinical to treat acute liver failure or fulminant liver failure.

参考文献:

[1] Margarit C, BILBAO I, CHARCO R. Auxiliary heterotopic liver transplantation with portal vein arterialization for fulminant hepatic failure. 2000(6). doi:10.1053/jlts.2000.18492
[2] Erhard J, LANGE R, RAUEN U. Auxiliary liver transplantation with arterialization of the portal vein for acute hepatic failure, 1998(4)
[3] Van Hoek B, De BOER J, BOUDJEMA K. Auxiliary versus orthotopic liver transplantation for acute liver failure. 1999(4). doi:10.1016/S0168-8278(99)80202-5
[4] Roll C, BALLAUFF A, LANGE R. Heterotopic auxiliary liver transplantation in a 3-year-old boy with acute liver failure and aplastic anemia. 1997(4). doi:10.1097/00007890-199708270-00021
[5] Nagashima I, BERGMANN L, ALSINA A E. Auxiliary heterotopic partial liver transplantation in pigs with acute ischemic liver failure, 1997(17)
[6] FAN Y D, PRAET M, VANZIELEGHEM B. Effects of re-arterialization on early graft function and regeneration in the rat model of heterotopic auxiliary liver transplantation. 2000(1)
[7] FAN Y D, LEROUX ROELS G, PRAET M. Evaluation of graft viability in heterotopic auxiliary liver transplantation in the rat. 1999(6). doi:10.1080/089419399272313 

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