漸進的門脈遮断を利用した生体からの部分肝移植

渐进式门静脉阻断活体部分肝移植

• 批准号: 01480327
• 负责人: 中川原 章
• 金额: $ 1.92万
• 依托单位: Kyushu University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for General Scientific Research (B)
• 财政年份: 1989
• 资助国家: 日本
• 起止时间: 1989 至 无数据
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-01480327/
• 关键词: 同所性部分肝移植; 漸進的門脈遮断

アメロイドリングによる門脈遮断を利用した部分肝移植を従来行ってきた。本法の特長は肝左葉グラフトを同所性に移植し、一方Recipientの肝右葉を残し、門脈右枝を漸進的に遮断して術直後に肝機能を一部残すことである。従って、術中術後の門脈血行動態の変動も少く、侵襲の少い術式と考えられる。本年度は漸進的門脈遮断に代わり門脈右枝を一期的に結紮する方法で移植実験を行い本法と比較した。さらに術中術後の門脈血行動態の変動を調べるため、肝左葉温阻血再灌流モデルを作製し、現在検討中である。1)移植実験(雑種成犬10回)門脈右枝を一期的に結紮すると全門脈血が肝左葉グラフトに一挙に流れ込み、虚血障害肝ではその全てを流すことは難しいと考えられる。実際本年度行った10回の移植実験では4例に門脈右枝結紮直後より、それまで安定していた動脈血圧の低下がみられ、早期死亡した。この現象は漸進的門脈遮断法ではみられなかった。2)肝左葉温阻血再灌流モデルの作製肝中葉切除を施行して、右葉と左葉を完全に分離し、左葉への門脈枝、肝動脈枝を一時遮断して(約30分)、肝左葉に温阻血障害を与えた。この際門脈血は肝右葉を通して流れ、門脈うっ血をきたさない。遮断解除後、肝左葉は再灌流され、阻血再灌流障害モデルとなる。3)温阻血障害肝における門脈血行動態の変動(雑種成犬4回)上記2)のモデルにより再灌流後、門脈右枝を一期的に結紮することによる門脈血流量、門脈血圧、動脈血圧に及ぼす変化をみた。門脈右枝結紮後に明らかな門脈血流量の低下がみられ、門脈血うっ滞の状態になると考えられた。今後、漸進的遮断法でも同モデルで行い、一期的結紮法と比較検討してゆく。

Amino Portal Vein Transplantation is performed using partial liver transplantation. The specialty of this method is that the left lobe of the liver can be transplanted with the same sex, the right lobe of the liver as a recipient can be transplanted, and the right branch of the portal vein can be gradually cut off and the liver function can be restored after straightening.従って, portal blood flow dynamics during and after surgery, less changes in portal blood flow, less invasion, less surgical style, and less risk. This year, the gradual portal vein occlusion and the first-stage ligation of the right branch of the portal vein were carried out and compared with the transplantation method. The portal blood flow dynamics during and after the operation were adjusted, and the left lobe of the liver was warm and blood-blocking and reperfused. 1) Transplantation (10 times in adult dogs) of the right branch of the portal vein and the first-stage ligation of the whole portal blood and the left lobe of the liverラフトに一挙に流れ込み, deficiency of blood impedes the liver, ではその全てを流すことは多しいと考えられる. This year, 4 cases of 10 transplants were performed, and the results were positive after ligation of the right branch of the portal vein, stabilization, low arterial blood pressure, and early death. This phenomenon is a gradual portal vein interruption method. 2) The left lobe of the liver was reperfused with thermostatic blood obstruction and the middle lobe resection was performed. The right lobe and the left lobe were completely separated. The portal vein branch and hepatic artery branch of the left lobe were temporarily blocked (about 30 minutes). The left lobe of the liver was not damaged by thermostatic blood obstruction. The blood from the portal vein flows through the right lobe of the liver, and the blood from the portal vein flows through the right lobe of the liver. After the blockage is lifted, the left lobe of the liver is free of reperfusion, and the blood occlusion and reperfusion disorders are reduced. 3) Thermoresistive blood disorder and changes in liver and portal blood flow (4 chapters in adult dogs) mentioned above 2) After reperfusion of the thermostatic blood vessels , the first-stage ligation of the right branch of the portal vein, the portal blood flow, the portal blood pressure, the arterial blood pressure, and the ligation of the right branch of the portal vein. After ligation of the right branch of the portal vein, it was found that the portal blood flow was reduced and the portal blood was stagnant. From now on, the gradual interruption method will be the same as the モデルで行い, and the one-stage ligation method will be compared with 検検てゆく.