Hemodynamic interaction between portal vein and hepatic artery flow in small-for-size split liver transplantation
Hemodynamic interaction between portal vein and hepatic artery flow in small-for-size split liver transplantation
复制标题
小型劈离式肝移植中门静脉与肝动脉血流动力学相互作用
DOI：
10.1007/s00147-002-0425-x
复制
发表时间：
2002
影响因子：
3.1
通讯作者：
J. Contis
中科院分区：
文献类型：
--
作者：
V. Smyrniotis;G. Kostopanagiotou;A. Kondi;E. Gamaletsos;K. Theodoraki;D. Kehagias;K. Mystakidou;J. Contis
在裂肝移植中，整个门静脉血流通过相对较小的同种大小的移植物重定向。据推测，过多的门静脉血流会导致移植物损伤。为了阐明这种损伤的机制，我们在猪的实验模型中研究了门静脉和肝动脉流动之间的血流动力学相互作用。第1组（n=6）全肝移植6块，第2组（n=6）全肝移植6块，第3组（n=6）全肝移植6块。1组、2组和3组的肝脏体积比分别为1:1、2:3和1:3。在移植物再灌注后60,120和180min用超声流量计测量门静脉和肝动脉流量。同时记录门静脉压力。再灌注后3、6、12小时观察移植物功能，12小时观察形态学变化。再灌注后，门静脉流量与移植物大小呈反比关系，而肝动脉流量则与移植物大小成比例减少。三组间差异有统计学意义（P<0.05）。3组门静脉压力显著高于1、2组（P<0.05）。3组肝动脉缓冲反应较1、2组明显增高（P<0.05）。劈裂肝移植，当产生小尺寸的移植物时，与门静脉高压、动脉血流减少和移植物功能障碍有关。动脉血流损伤似乎与门静脉血流增加有关。
In split‐liver transplantation, the entire portal flow is redirected through relatively small‐for‐size grafts. It has been postulated that excessive portal blood flow leads to graft injury. In order to elucidate the mechanisms of this injury, we studied the hemodynamic interactions between portal vein‐and hepatic artery flow in an experimental model in pigs. Six whole pig liver grafts were implanted in Group 1 (n=6) and six whole liver grafts were split into right and left grafts and transplanted to Groups 2 (n=6) and 3 (n=6), respectively. The graft‐to‐recipient liver volume ratio was 1:1, 2:3 and 1:3 in Groups 1, 2 and 3, respectively. Portal vein‐and hepatic artery flows were measured with an ultrasonic flow meter at 60,120 and 180min after graft reperfusion. Portal vein pressure was also recorded at the same time intervals. Graft function was assessed at 3,6h and 12h, and morphological changes at 12h after reperfusion. Following reperfusion, portal vein flow showed an inverse relationship to graft size, while hepatic artery flow was reduced proportionately to graft size. The difference was significant among the three groups (P<0.05). Portal vein pressure was significantly higher in group 3, compared to groups 1 and 2 (P<0.05). Hepatic artery buffer response was significantly higher in Group 3, compared to Groups 1 and 2 in relation to preocclusion values (P<0.05). Split‐liver transplantation, when resulting in small‐for‐size grafts, is associated with portal hypertension, diminished arterial flow, and graft dysfunction. Arterial flow impairment appears to be related to increased portal vein flow.