肝动脉桥式转流维持犬移植肝肝动脉血流的作用

目的介绍一种新的解决原位肝移植中肝动脉缺血(hepatic arterial ischemia,HAI)的方法:应用肝动脉桥式转流(hepatic arterial bridge bypass,HABB)维持动脉吻合时供肝肝动脉血流,并对其血流动力学参数变化进行初步观察。方法选择健康雄性西安地区杂交犬20只,制作犬简易自体原位肝移植模型,通过腹主动脉建立肝动脉桥式转流,测量转流前、转流15 min和转流结束1h肝动脉峰值流速(peak velocity,PV)和血流量(blood flow,BF),并统计腹主动脉插管时间和并发症。结果转流情况下肝动脉内血流峰值流速和血流量低于转流前(P<0.05),分别为转流前的83%和80%;在转流结束,开放肝动脉1h后,其血流动力学参数与转流前没有显著性差异。平均腹主动脉插管时间3 min,2例出现腹主动脉插管后荷包缝合处出血。结论肝动脉桥式转流是一种简便而有效的解决原位肝移植中肝动脉缺血的方法,但是这一方法仍然需要继续完善和改进。

Role of hepatic arterial bridge bypass in maintaining hepatic arterial bloodstream in canine transplanted liver

Objective To introduce a new method for hepatic arterial ischemia(HAI) in orthotopic liver transplantation-applying hepatic arterial bridge bypass(HABB) to maintain hepatic arterial bloodstream while the arterial anastomosis is going on,and hemodynamic parameters are also measured at the same time. Methods Altogether 20 canine models of liver autotransplantation were constructed,HABB procedure was performed from abdominal aorta to hepatic artery.Arterial peak velocity and blood flow were measured at the time of pre-HABB,HABB for 15 min and 1h after HABB ended and hepatic artery opened;morbidity of complications was calculated.Results Arterial peak speed and volume of blood flow in HABB 15 min were significantly below the levels in pre-HABB(P <0.05),about 83% and 80% of the latter;but in post-HABB situation after hepatic artery opened for 1h,the difference from pre-HABB was not obvious.The average time of abdominal aorta catheterization was 3 min,abdominal aorta bleeding occurred in 2 cases at the location of purse-string suture. Conclusion We deem that HABB could be a convenient and effective strategy for HAI in orthotopic liver transplantation,but it still needs to be improved.