Experimental studies on orthotopic partial hepatic transplantation in dogs.

本研究旨在探讨犬原位部分肝移植(PHTX)后供体和受体的长期存活情况。1.犬扩大肝切除同时切断残肝肝动脉后的病理生理及辅酶的作用：由于PHTX中肝动脉吻合必须在供肝肝总动脉和受体肝总动脉之间进行，供体肝切除后必须切断残肝肝动脉。在青霉素等抗生素的作用下，犬70%肝切除并刺激性阻断肝动脉的4周存活率为43%，并出现严重的肝功能障碍。而在青霉素和辅酶10联合应用下，小鼠四周存活率显著提高，达88%，残肝功能维持良好，…电磁血流仪测得的残肝血流量相对增加。可抑制残肝组织和血浆中过氧化脂质的升高，为PHTX的供体提供了实验依据。2.静脉-静脉转流原位全肝移植：10例受者中，7例存活3天以上，3例在36~72小时内死亡。无论是术中静脉输液处理，还是肝脏保存技术，均取得了较好的效果。3.PHTX：15例受者中，3例存活3天以上，12例48小时内死亡。技术问题是死亡的主要原因，12只狗在48小时内死亡，但少数病例是肝动脉血栓形成和纳米造口。另一方面，依靠多个监护仪顺利完成了术中和术后的管理。3例受者中有2例在PHTX免疫排斥反应死亡后存活3天以上，但术后肝功能变化与THTX相似，24小时内逐渐恶化，24小时后逐渐好转。PHTX中，由于可能来自活体供体，供肝为新鲜供体，移植后肝功能变化与THTX相似。因此，通过改进手术技巧和应用强效免疫抑制剂，可使PHTX术后长期存活成为可能。此后，我们想要调查PHTX中肝移植体积的允许限度。较少

The purpose of this investigation is to obtain the long term survival of both donor and the recipient at the same time after the orthotopic partial hepatic transplantation (PHTX) in dog. 1. Pathophysiology and effect of Coenzym _<10> (Co _<10>) after extended hepatectomy with simultaneous interruption of the hepatic artery of the remnant liver in dogs : Because hepatic artery anastomosis in PHTX must be performed between common hepatic artery of the graft and common hepatic artery of the recipient, interruption of the hepatic artery of the remnant liver is necessary after hepatectomy in donor. Under the administration of antibiotics such as penicillin, the four weeks survival rate of 70% hepatectomy with stimultaneous interruption of the hepatic artery in dogs was 43% and severe livedr dysfunction occurred. However, under the administration of both penicillin and Co _<10>, the four weeks survival rate was significantly improved to 88%, the remnant liver function was mainteined well and … More the blood flow of the remnant liver measured by electro-magnetic flow meter was relatively increased. Co _<10> inhibited the increase of lipide peroxide in the remnant liver tissues and plasma, so that it may use this model for the donor of PHTX. 2. Orthotopic total hepatic transplantation (THTX) using veno-venus bypass : Of the 10 recipients, 7 survived more than 3 days and 3 died in 36 to 72 hours. It was obtained the reasonable results for IV fluid managements during operation or the preservation technique of the liver. 3. PHTX : Of the 15 recipients, 3 survived more than 3 days and 12 died within 48 hours. Technical problems were the main cause of death in the 12 dogs died within 48 hours, however thrombosis of hepatic artery a nanstomosis was in a few cases. On the other hand, the intra-and postoperative management was performed smoothly depending on several monitors. Although 2 of the 3 recipients survived more than 3 days after PHTX died with immunological rejection, changes of the liver function after PHTX in these 3 cases was similar to the cases after THTX, which were getting worse within 24 hours and gradually improved after 24 hours.In PHTX, liver graft is fresh because of possible procurement from living donor and changes of the liver function after hepatic transplantation is not difference between PHTX and THTX. Therefore, to obtain the long term survival after PHTX may be possible by improvement of operative technique and use of strongly effective immunosuppresive agent. Hereafter, we would like to investigate the permissible limits of the volume of the liver graft in PHTX. Less