大鼠脾切除脾窝异位辅助肝移植动物模型的建立

发布时间：2018-08-24 10:03

【摘要】： 目的建立大鼠脾切除脾窝异位辅助肝移植并门静脉动脉化动物模型，观察术后大鼠生存率，研究供肝对大鼠肝功能衰竭的支持作用和供肝门静脉动脉血供对供肝早期的影响，并观察术后移植肝和原肝的形态学变化。方法将切除85％肝脏的急性肝功能衰竭SD大鼠(雌雄不限)随机分为二组：A组(n=30)，切除左肾及脾脏。将30％的供体肝脏植入大鼠左上腹，分别将供肝门静脉与受体左肾动脉、供体肝肝下下腔静脉与受体左肾静脉行支架管连接。门静脉采用内径为0.3mm左右的聚乙烯支架管与受体左肾动脉吻合来对供肝门静脉进行一定程度的限流。将供体肝脏胆总管用支架管插入受体十二指肠内行荷包缝合固定；B组(n=10)，为对照组，进行85％肝脏切除术和脾切除术。观察肝衰组和移植组大鼠生存情况，分别取A组大鼠1天3天5天7天血清做肝功能检测，并且于第7天将存活大鼠处死取出供体肝和原肝切片，观察组织学变化。结果A组30只大鼠中1只死于手术中大出血。术后4小时内有2只死亡，死于术后出血。2只大鼠死于术后48小时内，死于胆漏、肠道梗阻、胆汁性腹膜炎。3只死于术后3天，原因为移植肝脏门静脉血栓。1只死于未知原因，21只存活超过一周，一周存活率为70％。而B组10只大鼠中8小时内死亡2只，48小时死亡6只。2只大鼠存活1周；肝功能检测：A组大鼠血清ALT、AST、PT、Tbil值随时间变化逐渐接近正常值，一周后肝功能值与术后第一天相比有明显的降低(P＜0.5)和对照组大鼠肝功能相比也具有显著差异(P＜0.5)。移植术后7天，发现A组残肝体积一定程度增大，移植肝颜色轻度改变，显微镜下见残肝内肝细胞明显增生；而移植肝汇管区出现少量淋巴细胞侵润，，肝细胞未出现明显增生或凋亡等组织学改变。B组存活1周的大鼠残肝体积也有一定程度的增大。结论： 1、成功建立了大鼠脾切除脾窝异位辅助并门静脉动脉化肝移植动物模型。探索出了一种可行的异位辅助性肝移植动物模型的制作方法。 2、一周后原肝体积有一定程度增加，原肝肝细胞出现一定程度再生。在原肝功能恢复过程中移植肝短期内未出现明显的变化。 3、辅助肝脏为急性肝功能衰竭提供了有效的支持作用，有效的帮助肝衰大鼠度过肝衰早期。 4、由于本实验过程中未触及原肝胆总管，门静脉等重要结构，也为临床肝移植提供一种新的思路。 5、我们在本实验中仅仅研究了供肝对大鼠急性肝功能衰竭短期内的影响，但供肝对急性肝功能衰竭的长期影响、两肝之间增生、萎缩和血流变化等关系还有待今后实验进一步研究。
[Abstract]:Objective to establish an animal model of heterotopic liver transplantation and portal vein arterialization in rats with splenectomy and splenic fossa, observe the survival rate of rats, and study the supportive effect of donor liver on liver failure in rats and the effect of donor portal vein arterial blood supply on the early stage of donor liver. The morphologic changes of transplanted liver and original liver were observed. Methods SD rats with 85% liver failure were randomly divided into two groups: group A (n = 30) and group A (n = 30). The left kidney and spleen were resected. 30% of the donor liver was implanted into the left upper abdomen of the rat. The donor portal vein was connected with the recipient left renal artery and the donor subhepatic inferior hepatic vena cava was connected with the recipient left renal vein. The portal vein was anastomosed with the left renal artery of the recipient by polyethylene stent with the diameter of 0.3mm to limit the flow of the donor portal vein to a certain extent. The donor liver choledochus was inserted into the recipient duodenum by pocket suture and fixed in group B (n = 10). 85% hepatectomy and splenectomy were performed in the control group. The survival status of the rats in the liver failure group and the transplantation group were observed. The serum of the rats in group A was taken out 3 days, 5 days and 7 days to test the liver function, and the donor liver and the original liver sections were taken out on the 7th day, and the histological changes were observed. Results one of the 30 rats in group A died of massive hemorrhage during operation. 2 died within 4 hours after operation, 2 rats died of postoperative hemorrhage within 48 hours, died of bile leakage, intestinal obstruction, biliary peritonitis, and died 3 days after operation. The reason was that 21 patients died of portal vein thrombosis for more than a week, and the survival rate was 70 weeks. In group B, 2 rats died within 48 hours, 2 rats died within 48 hours and 6 rats survived for 1 week. After one week, the liver function value was significantly lower than that on the first day after operation (P < 0.5) and there was also significant difference between the control group and the control group (P < 0.5). 7 days after transplantation, it was found that the volume of residual liver in group A was increased to a certain extent, the color of the transplanted liver was slightly changed, the hepatocytes in the residual liver were obviously proliferated under the microscope, and a small amount of lymphocytes infiltrated the portal area of the transplanted liver. There were no histological changes such as proliferation or apoptosis in hepatocytes. The residual liver volume in group B also increased to a certain extent after one week survival. Conclusion: 1. The animal model of splenectomy and portal vein arterialized liver transplantation was established successfully. A feasible animal model of heterotopic adjuvant liver transplantation was developed. 2. After one week, the volume of primary liver increased to a certain extent, and the hepatocytes regenerated to a certain extent. During the recovery of the original liver function, there was no obvious change in the liver transplantation. 3. The auxiliary liver provided effective support for acute liver failure. It can effectively help the rats to get through the early stage of liver failure. 4. In this experiment, we did not touch the important structures such as the common hepatic bile duct, portal vein and so on. It also provides a new way of thinking for clinical liver transplantation. 5. In this experiment, we only studied the short-term effects of donor liver on acute liver failure in rats. However, the long-term effects of donor liver on acute hepatic failure, the relationship between proliferation, atrophy and blood flow between the two livers need to be further studied in the future.
【学位授予单位】：昆明医学院
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R-332

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