目的研究无肝期前后与异丙酚代谢相关的尿苷二磷酸葡萄糖醛酸转移酶ugt1a6在大鼠肾脏中的基因表达变化,初步阐释异丙酚无肝期肝外代谢特点形成的原因。方法15只雄性大鼠随机分为3组(5只/组),A组为对照组,B组阻断肝门30 m in,C组阻断肝门...目的研究无肝期前后与异丙酚代谢相关的尿苷二磷酸葡萄糖醛酸转移酶ugt1a6在大鼠肾脏中的基因表达变化,初步阐释异丙酚无肝期肝外代谢特点形成的原因。方法15只雄性大鼠随机分为3组(5只/组),A组为对照组,B组阻断肝门30 m in,C组阻断肝门60 m in,截取各组大鼠肾脏组织,采用逆转录聚合酶链式反应(RT-PCR)技术,检测各组ugt1a6 mRNA的表达。结果大鼠肾脏组织ugt1a6的基因表达水平B、C组明显高于A组(P<0.05);B组与C组相比,无显著差异(P>0.05)。结论大鼠肾脏组织ugt1a6基因表达在无肝期比无肝期前增多,这可能是异丙酚无肝期肝外代谢增强的机制之一。展开更多
AIM: To explore hemodynamics and vasoactive substance levels during renal vein congestion that occurs in the anhepatic phase of liver transplantation.METHODS: New Zealand rabbits received ligation of the hepatic pedic...AIM: To explore hemodynamics and vasoactive substance levels during renal vein congestion that occurs in the anhepatic phase of liver transplantation.METHODS: New Zealand rabbits received ligation of the hepatic pedicle, supra-hepatic vena cava and infrahepatic vena cava [anhepatic phase group(APH); n = 8], the renal veins(RVL; n = 8), renal veins and hepatic pedicle [with the inferior vena cava left open)(RVHP; n = 8)], or a sham operation(SOP; n = 8). Hemodynamic parameters(systolic, diastolic, and mean arterial blood pressures) and the levels of serum bradykinin(BK) and angiotensin Ⅱ(ANGII) were measured at baseline(0 min), and 10 min, 20 min, 30 min, and 45 min after the surgery. Correlation analyses were performed to evaluate the associations between hemodynamic parameters and levels of vasoactive substances.RESULTS:All experimental groups(APH,RVL,and RVHP)showed significant decreases in hemodynamic parameters(systolic,diastolic,and mean arterial blood pressures)compared to baseline levels,as well as compared to the SOP controls(P<0.05 for all).In contrast,BK levels were significantly increased compared to baseline in the APH,RVL,and RVHP groups at all time points measured(P<0.05 for all),whereas no change was observed in the SOP controls.There were no significant differences among the experimental groups for any measure at any time point.Further analyses revealed that systolic,diastolic,and mean arterial blood pressures were all negatively correlated with BK levels,and positively correlated with ANGII levels in the APH,RVL,and RVHP groups(P<0.05 for all).CONCLUSION:In the anhepatic phase of orthotopic liver transplantation,renal vein congestion significantly impacts hemodynamic parameters,which correlate with serum BK and ANGII levels.展开更多
BACKGROUND: To evaluate feasibility and safety of venovenous bypass prior to mobilization of the liver during orthotopic liver transplantation (OLT). METHODS: Fifty-four patients were classified into two groups. Group...BACKGROUND: To evaluate feasibility and safety of venovenous bypass prior to mobilization of the liver during orthotopic liver transplantation (OLT). METHODS: Fifty-four patients were classified into two groups. Group A consisted of 23 patients receiving OLT with classical venovenous bypass. Group B consisted of 31 patients who received a modified-procedure: venovenous bypass ahead of the mobilization of the liver during ULT. The blood loss, duration of venovenous bypass, cold ischemia time, anhepatic phase, and transfusion during operation in the two groups were compared. Complications after the operation were also compared between the two groups. RESULTS: The duration of venovenous bypass and cold ischemia time in group A were longer than those in group B [(99.78±21.36 min) vs (96.32±22.25 min) and (484.78±134.01 min) vs (443.15± 85.27 min)]. The anhepatic phase lasted for about 100 min averagely in the two groups. The volumes of blood loss and transfusion during the operation were larger in group A than in group B [(5096±4243 ml) vs (1726±1125 ml) and (3676±2938.74 ml) vs (1217.69±829.72 ml)]. Postoperative complications occurred in 26 patients of group A and in 19 patients of group B. CONCLUSION: This modified-procedure or venovenous bypass ahead of mobilization of the liver in OLT can reduce the blood loss during OLT and the incidence of postoperative complications without prolongation of the anhepatic phase and duration of venovenous bypass.展开更多
目的探讨异丙酚持续恒速输注在大鼠无肝期前后血药浓度变化规律、肝外代谢、肺脏对异丙酚肝外代谢的作用。方法通过大鼠左颈深静脉持续恒速输注异丙酚,于分离肝门时、肝门阻断即刻、肝门阻断15、30、60 m in等时间点,同时从右侧颈深动...目的探讨异丙酚持续恒速输注在大鼠无肝期前后血药浓度变化规律、肝外代谢、肺脏对异丙酚肝外代谢的作用。方法通过大鼠左颈深静脉持续恒速输注异丙酚,于分离肝门时、肝门阻断即刻、肝门阻断15、30、60 m in等时间点,同时从右侧颈深动、静脉分别采血(100μl),采用高效液相色谱荧光法(HPLC)检测异丙酚血药浓度。结果颈深静脉或颈深动脉异丙酚血药浓度各时相点间比较,肝门阻断15、30、60 m in时的血药浓度比阻断前和阻断即刻明显升高(P<0.01),但3组间没有显著性差异(P>0.05);颈深静脉与颈深动脉异丙酚血药浓度比较,任何时刻均无显著性差异(P>0.05)。结论肝脏是异丙酚主要代谢器官,异丙酚存在肝外代谢,肺脏不是异丙酚肝外代谢的主要器官。展开更多
目的介绍右半肝劈离式肝移植时采用的简化“All in one”的肝静脉重建手术方式,探讨该术式的临床适应证、操作方式和预后。方法回顾性分析2例完全右半肝劈离式肝移植的病例资料,就右半肝肝静脉采用简化“All in one”重建方式进行总结...目的介绍右半肝劈离式肝移植时采用的简化“All in one”的肝静脉重建手术方式,探讨该术式的临床适应证、操作方式和预后。方法回顾性分析2例完全右半肝劈离式肝移植的病例资料,就右半肝肝静脉采用简化“All in one”重建方式进行总结分析。2例右半肝均为在体劈离,例1采用劈离肝实质至第一、二肝门,离断右肝管后整体灌注获取,台下分割肝脏血管的方法。例2采用在体劈离时先行获取左半肝,右半肝行在体灌注后获取。2例供肝劈离时均将肝中静脉主干保留于左半肝,右半肝的S5、S8段肝静脉采用同一供者髂动脉重建,并直接吻合于下腔静脉上原肝左和肝中静脉离断后的缺口,重建了肝后下腔静脉的完整性。结果采用简化“All in one”右半肝肝静脉重建方式,2例肝移植无肝期分别为41、36 min。肝脏开放后供肝回流良好,搭桥的髂动脉血管充盈满意,无肝脏淤血肿胀等表现,术后肝功能恢复顺利。分别随访1年11个月和10个月,无肝静脉和下腔静脉等流出道相关并发症发生。结论完全右半肝劈离式肝移植时,采用“All in one”的肝静脉重建方式可以简化移植肝脏流出道重建步骤、缩短无肝期时间,减少术后肝静脉并发症的发生。展开更多
文摘目的研究无肝期前后与异丙酚代谢相关的尿苷二磷酸葡萄糖醛酸转移酶ugt1a6在大鼠肾脏中的基因表达变化,初步阐释异丙酚无肝期肝外代谢特点形成的原因。方法15只雄性大鼠随机分为3组(5只/组),A组为对照组,B组阻断肝门30 m in,C组阻断肝门60 m in,截取各组大鼠肾脏组织,采用逆转录聚合酶链式反应(RT-PCR)技术,检测各组ugt1a6 mRNA的表达。结果大鼠肾脏组织ugt1a6的基因表达水平B、C组明显高于A组(P<0.05);B组与C组相比,无显著差异(P>0.05)。结论大鼠肾脏组织ugt1a6基因表达在无肝期比无肝期前增多,这可能是异丙酚无肝期肝外代谢增强的机制之一。
基金Supported by Natural Science Foundation of Gansu Province,China,No.3ZS051-A25-104Clinical Medicine Research Special Funds of Chinese Medical Association,China,No.14040360573
文摘AIM: To explore hemodynamics and vasoactive substance levels during renal vein congestion that occurs in the anhepatic phase of liver transplantation.METHODS: New Zealand rabbits received ligation of the hepatic pedicle, supra-hepatic vena cava and infrahepatic vena cava [anhepatic phase group(APH); n = 8], the renal veins(RVL; n = 8), renal veins and hepatic pedicle [with the inferior vena cava left open)(RVHP; n = 8)], or a sham operation(SOP; n = 8). Hemodynamic parameters(systolic, diastolic, and mean arterial blood pressures) and the levels of serum bradykinin(BK) and angiotensin Ⅱ(ANGII) were measured at baseline(0 min), and 10 min, 20 min, 30 min, and 45 min after the surgery. Correlation analyses were performed to evaluate the associations between hemodynamic parameters and levels of vasoactive substances.RESULTS:All experimental groups(APH,RVL,and RVHP)showed significant decreases in hemodynamic parameters(systolic,diastolic,and mean arterial blood pressures)compared to baseline levels,as well as compared to the SOP controls(P<0.05 for all).In contrast,BK levels were significantly increased compared to baseline in the APH,RVL,and RVHP groups at all time points measured(P<0.05 for all),whereas no change was observed in the SOP controls.There were no significant differences among the experimental groups for any measure at any time point.Further analyses revealed that systolic,diastolic,and mean arterial blood pressures were all negatively correlated with BK levels,and positively correlated with ANGII levels in the APH,RVL,and RVHP groups(P<0.05 for all).CONCLUSION:In the anhepatic phase of orthotopic liver transplantation,renal vein congestion significantly impacts hemodynamic parameters,which correlate with serum BK and ANGII levels.
文摘BACKGROUND: To evaluate feasibility and safety of venovenous bypass prior to mobilization of the liver during orthotopic liver transplantation (OLT). METHODS: Fifty-four patients were classified into two groups. Group A consisted of 23 patients receiving OLT with classical venovenous bypass. Group B consisted of 31 patients who received a modified-procedure: venovenous bypass ahead of the mobilization of the liver during ULT. The blood loss, duration of venovenous bypass, cold ischemia time, anhepatic phase, and transfusion during operation in the two groups were compared. Complications after the operation were also compared between the two groups. RESULTS: The duration of venovenous bypass and cold ischemia time in group A were longer than those in group B [(99.78±21.36 min) vs (96.32±22.25 min) and (484.78±134.01 min) vs (443.15± 85.27 min)]. The anhepatic phase lasted for about 100 min averagely in the two groups. The volumes of blood loss and transfusion during the operation were larger in group A than in group B [(5096±4243 ml) vs (1726±1125 ml) and (3676±2938.74 ml) vs (1217.69±829.72 ml)]. Postoperative complications occurred in 26 patients of group A and in 19 patients of group B. CONCLUSION: This modified-procedure or venovenous bypass ahead of mobilization of the liver in OLT can reduce the blood loss during OLT and the incidence of postoperative complications without prolongation of the anhepatic phase and duration of venovenous bypass.
文摘目的探讨异丙酚持续恒速输注在大鼠无肝期前后血药浓度变化规律、肝外代谢、肺脏对异丙酚肝外代谢的作用。方法通过大鼠左颈深静脉持续恒速输注异丙酚,于分离肝门时、肝门阻断即刻、肝门阻断15、30、60 m in等时间点,同时从右侧颈深动、静脉分别采血(100μl),采用高效液相色谱荧光法(HPLC)检测异丙酚血药浓度。结果颈深静脉或颈深动脉异丙酚血药浓度各时相点间比较,肝门阻断15、30、60 m in时的血药浓度比阻断前和阻断即刻明显升高(P<0.01),但3组间没有显著性差异(P>0.05);颈深静脉与颈深动脉异丙酚血药浓度比较,任何时刻均无显著性差异(P>0.05)。结论肝脏是异丙酚主要代谢器官,异丙酚存在肝外代谢,肺脏不是异丙酚肝外代谢的主要器官。
文摘目的介绍右半肝劈离式肝移植时采用的简化“All in one”的肝静脉重建手术方式,探讨该术式的临床适应证、操作方式和预后。方法回顾性分析2例完全右半肝劈离式肝移植的病例资料,就右半肝肝静脉采用简化“All in one”重建方式进行总结分析。2例右半肝均为在体劈离,例1采用劈离肝实质至第一、二肝门,离断右肝管后整体灌注获取,台下分割肝脏血管的方法。例2采用在体劈离时先行获取左半肝,右半肝行在体灌注后获取。2例供肝劈离时均将肝中静脉主干保留于左半肝,右半肝的S5、S8段肝静脉采用同一供者髂动脉重建,并直接吻合于下腔静脉上原肝左和肝中静脉离断后的缺口,重建了肝后下腔静脉的完整性。结果采用简化“All in one”右半肝肝静脉重建方式,2例肝移植无肝期分别为41、36 min。肝脏开放后供肝回流良好,搭桥的髂动脉血管充盈满意,无肝脏淤血肿胀等表现,术后肝功能恢复顺利。分别随访1年11个月和10个月,无肝静脉和下腔静脉等流出道相关并发症发生。结论完全右半肝劈离式肝移植时,采用“All in one”的肝静脉重建方式可以简化移植肝脏流出道重建步骤、缩短无肝期时间,减少术后肝静脉并发症的发生。
