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目的:探索原位小肠移植的手术技术,为研究移植小肠功能及排斥反应提供良好的动物模型。方法:采用小肠供体的门静脉与受体下腔静脉端侧吻合,供体带主动脉片的肠系膜上动脉与受体腹主动脉端侧吻合,受体相应长度肠管切除,供体近、远端肠管与受体相应肠管切除后近、远端以端端吻合的方式建立原位小肠移植模型。术后禁食4 d,不禁饮,每天分2次经皮下分别给予5%葡萄糖生理盐水2 mL,术后不使用抗生素和免疫抑制剂。小鼠存活超过5 d认为手术成功。结果:行原位小肠移植30次,术后5 d存活率达60%(18/30)。手术失败的12例小鼠主要死亡原因为动脉吻合口部位狭窄及吻合口处血栓形成5例,吻合口出血导致出血性休克2例,术后肠瘘导致腹腔内感染5例。供体手术时间(40±4.5)min,热缺血时间约0.5min,供体肠段肠系膜上动脉组织片修整时间约为3 min,供体冷保存时间为(30±7.5)min,受体手术时间(95±8.0)min,其中腹主动脉及下腔静脉阻断时间为(38±3.5)min,静脉吻合时间(10±2.0)min,动脉吻合时间(15±3.0)min,成活小鼠受体手术平均出血量约0.2 mL。结论:良好的供体肠段的获取、高质量的血管吻合和肠道吻合及供、受体补液是提高小鼠小肠移植手术成功率的关键。
Objective: To explore the surgical technique of orthotopic small bowel transplantation and to provide a good animal model for the study of intestinal function and rejection. Methods: The portal vein of the small intestine donor was anastomosed with the inferior vena cava of the recipient. The superior mesenteric artery of the donor aorta was anastomosed with the abdominal aorta of the recipient. The corresponding length of the recipient was excised and the donor was near and far The proximal intestine and the recipient corresponding resection of the bowel near, distal end to end anastomosis to establish orthotopic small intestinal transplantation model. Postoperative fasting 4 d, can not help but drink, 2 times a day subcutaneously were given 5% glucose saline 2 mL, postoperative do not use antibiotics and immunosuppressive agents. Mice survived more than 5 days that surgery was successful. Results: The small bowel transplantation in situ 30 times, 5 d after the survival rate of 60% (18/30). The main causes of death in 12 cases of surgery were stenosis of arterial anastomotic site and thrombosis at anastomotic site in 5 cases, anastomotic bleeding resulted in 2 cases of hemorrhagic shock and postoperative intestinal fistula resulted in 5 cases of intra-abdominal infection. Donor operation time (40 ± 4.5) min, warm ischemic time of about 0.5min, donor mesenteric artery segment tissue piece dressing time of about 3 min, donor cold preservation time (30 ± 7.5) min, receptor The time of operation (95 ± 8.0) min, the time of occlusion of abdominal aorta and inferior vena cava (38 ± 3.5) min, venous anastomosis time (10 ± 2.0) min and arterial anastomosis time (15 ± 3.0) min, The average volume of murine receptor surgery was about 0.2 mL. Conclusion: Good donor intestine segment access, high quality vascular anastomosis and intestinal anastomosis and donor and recipient fluid replacement are the keys to improve the success rate of small bowel transplantation in mice.