Ｏｕｒ ｔｅｃｈｎｉｑｕｅ ｆｏｒ ａｕｘｉｌｉａｒｙ ｌｉｖｅｒ ｔｒａｎｓｐｌａｎｔａｔｉｏｎ ｗａｓ ｂａｓｅｄ ｏｎ ｔｈｅ ｔｅｃｈｎｉｑｕｅ ｄｅｓｃｒｉｂｅｄ ｂｙ Ｈｅｓｓ ｗｉｔｈ ｔｈｅ ｅｘｃｅｐｔｉｏｎ ｏｆ ｔｈｅ ｌｅｎｇｔｈ ｏｆ ｔｈｅ ｃｕｆｆ ｏｆ ｔｈｅ ｇｒａｆｔ ｖｅｎａ ｃａｖａ ａｎｄ ｅｓｔａｂｌｉｓｈｍｅｎｔ ｏｆ ｔｈｅ ｐｏｒｔａｌ ｖｅｉｎ ａｎａｓｔｏｍｏｓｉｓ．Ａ ｔｏｔａｌ ｏｆ ６０ ａｕｘｉｌｉａｒｙ ｌｉｖｅｒ ｔｒａｎｓｐｌａｎｔａｔｉｏｎｓ ｗｅｒｅ ｐｅｒｆｏｒｍｅｄ，ｏｆ ｗｈｉｃｈ ２４ ｗｅｒｅ ｄｅｆｉｎｉｔｉｖｅ ｏｐｅｒａｔｉｏｎ．Ｉｎ ｔｈｅ ５ ｄｅｆｉｎｉｔｉｖｅ ｏｐｅｒａｔｉｏｎｓ ｔｈｅ ｇｒａｆｔｓ ｓｕｒｖｉｖａｌ ａｓｓｅｓｓｅｄ ｂｙ ９７ｍＴｃｓｏｄｉｕｍ ｐｈｙｔａｔｅ ｄｅｍｏｎｓｔｒａｔｅｄ ａ １ｗｅｅｋ ｓｕｒｖｉｖａｌ ｏｆ １００％．Ｈｏｗ ｔｏ ｒｅｄｕｃｅ ｔｈｅ ｃｏｍｐｌｉｃａｔｉｏｎｓ ｉｎ ａｕｘｉｌｉａｒｙ ｌｉｖｅｒ ｔｒａｎｓｐｌａｎｔａｔｉｏｎ ｉｎ ｒａｔｓ ｉｓ ｄｉｓｃｕｓｓｅｄ ｉｎ ｔｈｅ ａｒｔｉｃｌｅ．
【Abstract】ObjectiveTo investigate the protective effects and the impact on the expression of Bcl-2 and Caspase-3 mRNA by Panax notoginseng saponins (PNS) preconditioning in rat liver transplantation. MethodsMale Sprague-Dawley rats were used as donors and recipients of orthotopic liver transplantation (OLT) and were divided into PNS preconditioning group (PNS group) and NS control group (NS group) randomly according to whether PNS was injected by venous (50 mg/kg) 1 h before liver grafts harvesting. The animals were respectively killed 2 h, 6 h and 24 h after reperfusion. Plasma samples were collected for ALT and AST test. Liver tissues were collected to detect histological changes, apoptosis and the expression of Bcl-2, Caspase-3 mRNA. ResultsThe serum levels of ALT and AST and the apoptosis index (AI) of liver tissue in PNS group were lower than those in NS group’s significantly (P＜0.05) at 2 h, 6 h and 24 h after reperfusion. The expression of Bcl-2 mRNA was enhanced significantly in PNS group at 6 h, 24 h after reperfusion and the expression of Caspase-3 mRNA was decreased significantly in PNS group at 2 h, 6 h after reperfusion as compared with NS group’s(P＜0.05). ConclusionPNS preconditioning can attenuate liver grafts ischemia/reperfusion injury and apoptosis of hepatocytes. Affecting expression of Bcl-2 and Caspase-3 genes may be one of the mechanisms of PNS antiapoptotic effects.
摘要:目的:探討床旁超聲檢查在肝移植術后下腔靜脈(IVC)并發癥診斷中的應用價值。方法:對424例肝移植術后患者進行床旁超聲檢查,對下腔靜脈并發癥,包括狹窄及栓塞的資料進行回顧性分析和總結。結果:床旁超聲檢查發現下腔靜脈并發癥患者18例,其中狹窄6例,栓塞12例。結論:床旁超聲檢查在肝移植術后,尤其是對術后早期發生的下腔靜脈并發癥的診斷及監測具有重要的作用,為臨床診斷和治療提供及時、有價值的影像學依據。Abstract: Objective: To evaluate the value of bedside ultrasound in diagnosis and monitoring of inferior vena cava (IVC) complications after liver transplantation. Methods: 424 cases with liver transplantation were examined by bedside ultrasound after the operations. The results of IVC complications,including thrombosis and stenosis, were analyzed and summarized. Results: 18 cases with IVC complications were detected by bedside ultrasound, including 6 cases of stenosis and 12 cases of thrombosis. Conclusion: Bedside ultrasound is important for diagnosing and monitoring IVC thrombosis and stenosis after liver transplantation, especially in the earlier period. It could provide valuable imaging for clinical diagnosis and treatment promptly.
【Abstract】 Objective To investigate the expression patterns of vascular endothelial growth factor (VEGF) mRNA as markers for isolated tumor cells in the peripheral blood of patients with hepatocellular carcinoma (HCC) following liver transplantation, and to evaluate the correlation between VEGF and the recurrence and metastasis of HCC following liver transplantation. Methods In this prospective study, 97 patients were divided into four groups according to the pathological results: HCC following liver transplantation group (HCC+LT group, n=53), advanced HCC group (n=8), benign liver diseases group (n=26) and healthy volunteers group (n=10), among which the 53 cases in HCC group were collected from April, 2002 to December, 2003. RNA was purified from the peripheral blood of the other 44 control patients and also from the patients in HCC group before, during and after liver transplantation in order to study the expression specificity of VEGF mRNA in HCC patients and its dynamic change during perioperative period. The correlation between VEGF and the tumor recurrence and metastasis was also analyzed by fluorescent quantitative reverse transcriptase and polymerase chain reaction (FQ RT-PCR). Results VEGF mRNA could be used as marker of isolated tumor cells for its high specificity. The positive rate of VEGF mRNA in HCC group and in advanced HCC group were 37.5% and 75.0%, respectively, which were significantly higher than that in benign liver diseases group (11.5%) and healthy volunteers group (10.0%), P＜0.01. The presence of preoperative VEGF mRNA and the consistent presence of postoperative VEGF mRNA might be relevant with the recurrence and metastasis HCC following liver transplantation （P＜0.01）. Conclusion The presence of preoperative VEGF mRNA and the consistent presence of postoperative VEGF mRNA may predict the recurrence and metastasis HCC following liver transplantation.
目的 探討脾動脈栓塞治療親體肝移植術后脾動脈竊血所致小肝綜合征的療效。方法 我院2007年4月至2009年9月期間共完成親體肝移植25例，其中有2例發生脾動脈竊血致小肝綜合征，均采用介入技術經皮行脾動脈栓塞治療。結果 行脾動脈栓塞術后，2例患者腹水逐漸減少，轉氨酶水平、血小板及白蛋白水平及肝功能較快恢復正常。栓塞術后1個月復查，肝功能仍基本正常。結論 脾動脈栓塞是治療肝移植術后脾動脈竊血所致小肝綜合征的有效措施。
【摘要】目的 總結分析原位背馱式肝移植手術后并發癥與供肝修整的關系。方法 回顧性分析我院12例行原位背馱式同種異體肝移植患者的資料。結果 本組12例肝移植圍手術期無死亡； 手術成功率為100%。12例中行動脈血管變異整形2例，門靜脈搭橋吻合1例； 各韌帶修剪后縫合7例，未縫合5例。手術后發生腹腔內出血3例，其中2例與供肝修整有關，即修肝時各韌帶未仔細縫合及結扎而導致細小血管出血，另1例系凝血功能障礙所致； 在供肝修整中注意了血管的變異整形及膽管的血供，術后無動脈及門靜脈血管并發癥和膽道并發癥發生。結論 修肝質量的好壞，直接關系到術中植肝時手術操作的難度、術后供肝的存活質量、并發癥的發生和患者的康復。
【Abstract】ObjectiveTo compare the hemodynamic changes during operation of portal venous intubation or splenic venous intubation in extracorporeal venous bypass of swine orthotopic liver transplantation.MethodsThirty couples of healthy Duloke pigs were selected to perform orthotopic liver transplantation. According to the difference of cannula vessel of portal venous system during extracorporeal venous bypass, these pigs were divided into two groups: portal venous intubation group (n=15) and splenic venous intubation group (n=15). Hemodynamic changes were monitored continuously.ResultsTwo recipients died in portal venous intubation group, one died of unsmooth bypass in the operation, the other died of DIC. In splenic venous intubation group there was only one recipient death, who died of hemorrhagic shock. The time of anhepatic phase of splenic venous intubation group was (44.5±7.6) min, it was significantly shorter than portal venous intubation group(51.5±8.7) min(P＜0.05). Hemodynamic changes in phase Ⅲ and phase Ⅳ of portal venous intubation group were significantly different with that of splenic venous intubation group(P＜0.05). ConclusionApplication of bypass through splenic venous intubation during extracorporeal venous bypass of swine orthotopic liver transplantation can shorten the time of anhepatic phase, keep the hemodymamics relative stable in operation, and reduce the occurrence of postoperative correlative complication. It is an effective venovenous bypass pathway.