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、受者的长期存活情况。1.犬<10><10>扩大肝切除同时阻断残肝肝动脉的病理生理及Coenzym _（Co _）的作用：PHTX中移植肝总动脉与受体肝总动脉必须吻合，因此供体肝切除后必须阻断残肝动脉。在使用青霉素等抗生素的情况下，70%肝切除加肝动脉阻断的犬4周存活率为43%，并出现严重肝功能障碍。而青霉素和钴联合应用<10>则明显提高了4周存活率，达88%，残肝功能维持良好， 关于我们 电磁流量计测得残肝血流量相对增加。Co _2<10>抑制了残肝组织和血浆中过氧化氢的升高，可用于PHTX供者模型。2.采用静脉-静脉转流的原位全肝移植（THTX）：10例受者中，7例存活超过3天，3例在36 ~ 72小时内死亡。对术中静脉输液管理或肝脏保存技术取得了较好的效果。3. PHTX：15例受者中，3例存活超过3天，12例在48小时内死亡。48小时内死亡的12只犬主要死亡原因为技术问题，少数为肝动脉血栓形成。另一方面，依靠多台监护仪，术中和术后管理得以顺利进行。3例受者中有2例存活3天以上，但术后肝功能变化与THTX相似，24 h内肝功能恶化，24 h后逐渐好转。肝移植术后肝功能的变化在PHTX组和PHTX组之间无差异，THTX。因此，通过改进手术技术和使用强有效的免疫抑制剂，可能获得PHTX术后的长期生存。因此，我们想探讨PHTX中移植肝体积的允许范围。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