[Induction of impaired hepatic microcirculation by in situ hilus preparation in liver explantation].
[Induction of impaired hepatic microcirculation by in situ hilus preparation in liver explantation].
复制标题
[肝移植中原位门制备诱导肝微循环受损]。
DOI：
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发表时间：
1995
期刊：
影响因子：
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通讯作者：
G. Otto
中科院分区：
文献类型：
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作者：
E. Klar;T. Kraus;B. Osswald;J. Bleyl;L. Fernandes;A. Mehrabi;W. Newman;M. Gebhard;C. Herfarth;G. Otto
目标
通常，在用保存液灌流之前，要进行肝门结构的原位准备。本研究的目的是探讨肝脏制剂对肝脏微循环的机械效应。
方法
将16头德国长白猪随机分为两组。两组气管插管后均行剖腹手术。随后，将热扩散探头植入肝左叶内侧，以定量测定微循环。A组(n=8)显露胆管、肝动脉、门静脉后横断小网膜。在肝动脉和门静脉周围放置超声体积探头。在肝脏准备结束后5分钟同时测量肝脏微血流和总肝脏血流量。B组(n=8)于开腹后45min测量肝脏微血流灌注，不作进一步处理。
结果
A组肝脏灌注量由78±13ml/100g/min降至61+/-16ml/100g/min。制备后，肝血流量为137+/-46ml/100g/min，分流率为51+/-21%。相比之下，B组在整个观察期内肝脏微灌注量维持在基线水平(79+/-3ml/100g/min对78+/-5ml/100g/min)。
结论
原位肝准备引起相应的肝脏微循环障碍。手术后不久，由于分流流量的增加，保存灌流可能变得无效。如果再生周期太短，例如缺乏心脏移植，移植肝的质量可能会受到限制。
AIM
Usually, in-situ preparation of the hepatic hilar structures is performed prior to the perfusion with preservation solution. Aim of this study was to investigate mechanical effects of liver preparation on the hepatic microcirculation.
METHODS
16 pigs (German landrace) were randomized in two groups. In both groups, laparotomy was performed after intratracheal intubation. Subsequently, a thermal diffusion probe was implanted into the medial left liver lobe for quantification of microperfusion. In group A (n = 8), bile duct, hepatic artery, and portal vein were exposed and the lesser omentum transsected thereafter. Ultrasound-volume-probes were placed around the hepatic artery and portal vein. Simultaneous measurement of hepatic microperfusion and total liver blood flow was performed five minutes after the end of liver preparation. In group B (n = 8) hepatic microperfusion was quantified 45 minutes after laparotomy without further manipulations.
RESULTS
By the preparation, liver perfusion was significantly reduced in group A from 78 +/- 13 ml/100g/min to 61 +/- 16 ml/100g/min. After preparation a total liver blood flow of 137 +/- 46 ml/100g/min was recorded indicating a shunt fraction of 51 +/- 21%. In contrast, hepatic microperfusion in group B remained at baseline during the whole observation period (79 +/- 3 ml/100g/min vs. 78 +/- 5 ml/100g/min).
CONCLUSION
In-situ liver preparation induces a relevant disturbance of hepatic microcirculation. Preservation perfusion shortly after surgical manipulation could become ineffective because of an increase in shunt flow. If the regeneration period is too short, e.g. lack of heart explantation, the quality of the liver graft could be limited.