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辅助性原位部分肝移植治疗肝豆状核变性的实验研究
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摘要
第一部分实验一小鼠原位肝移植模型的建立
     目的探讨小鼠原位肝移植模型技术的改进,为深入进行移植免疫、肝再生及缺血再灌注损伤等研究提供动物模型平台。方法按“双袖套”法完成小鼠原位肝移植模型50台,对供者手术、袖套安装及受者肝上下腔静脉吻合等方法进行技术改进,总结手术技巧,并评估手术时间、手术成功率及长期存活率。结果供者手术时间、受者无肝期时间及受者手术时间分别为(18±2)min、(17±2)min、(43±3) min。手术成功率为92%,100d存活率为85%。结论该方法可快速获取高质量供肝,同时无肝期的缩短可保证较高的手术成功率。
     第一部分实验二小鼠辅助性原位部分肝移植模型的建立目的探讨建立小鼠辅助性原位部分肝移植模型的技术方法,进一步为临床该术式的开展提供小动物的实验数据支持。方法完成小鼠辅助性原位部分肝移植模型50台,门静脉采用袖套法吻合,肝静脉采用端端丝线吻合,胆道采用支架胆肠吻合,总结手术技巧,并评估手术时间、手术成功率及长期存活率。结果供者手术时间、受者无肝期时间及受者手术时间分别为(30±3)min、(6±1)min、(58±5) min。手术成功率为96%,术后4w存活率为88%。结论该方法技术可靠,成功率高,可为辅助性原位部分肝移植的基础研究提供帮助。
     第二部分实验一Atp7b-/-小鼠的繁育、基因型鉴定及铜代谢特点分析
     目的探讨Atp7b-/-小鼠的繁育、基因型鉴定及铜代谢特点,进一步研究ATP7B基因对铜代谢的影响。方法繁育采取杂合子配种的方法,PCR鉴定子代基因型,铜含量采用原子吸收光谱法检测,并行HE染色检查组织病理学改变。结果基因型鉴定结果符合孟德尔规律,Atp7b-/-.小鼠肝铜一直处于较高的水平,为野生型对照的25倍以上;血清铜水平在20周龄达到高峰,约为同龄野生型对照的两倍,且20周龄几乎所有的Atp7b-/-.小鼠肝脏均出现炎症坏死、纤维化及再生结节形成。结论Atp7b-/-小鼠基因型遗传稳定,肝脏病理改变明显,是理想的模拟肝豆状核变性肝脏病变的动物模型。
     第二部分实验二辅助性原位部分肝移植治疗肝豆状核变性的实验研究
     目的探讨辅助性原位部分肝移植对肝豆状核变性小鼠的治疗效果。方法利用Atp7b-/-小鼠为受体,Atp7b+/+小鼠为供体,分8和20周龄两个时间点行左外叶辅助性原位部分肝移植,移植肝体积约为受体肝的38%,观察移植术后生存率,比较铜代谢和肝功能的相关指标的变化。结果8和20周龄时间点移植术后生存率分别为,术后血清铜、自身肝铜、血清铜蓝蛋白活性及肝功能指标均有改善,其中8周龄移植术后肾铜和脑铜水平较对照明显降低,自身肝的组织病理改变明显轻于对照;20周龄移植术后供肝明显增生,自身病肝萎缩,且更小体积的移植肝(约为受体肝的19%)也能纠正铜代谢的紊乱,能达到全肝移植效果,但较后者手术风险更低。结论左外叶辅助性原位部分肝移植可以替代全肝移植治疗肝豆状核变性,同时早期移植可以延缓肝脏病变的进程,减少铜在其他组织器官中的沉积,但具体最低多少体积肝脏可以满足机体铜代谢需要,有待进一步研究。
PartⅠExperimentⅠEstablishment of orthotopic liver transplantation in mice
     Objective To improve the technique of orthotopic liver transplantation model in mice and build animal model on the study of transplantation immunity, liver regeneration and ischemical reperfusion injury.
     Methods According to "two-cuff" method,the surgical technic of harvesting donor's liver,fixing the cuff and the anastomosis of superior and inferior caval vein were improved.
     Results The operation time of harvesting donor's liver and anhepatic phase and recipient were (18±2) min, (17±2) min and (43±3) min.The model success rate was 92%,and the 100-day survival was 85%.
     Conclusions High quality liver could be harvested by this improved method,and short anhepatic phase ensured the high model success rate.
     Part I Experiment II Establishment of auxiliary partial
     orthotopic liver transplantation in miceObjective To explore the technique of auxiliary partial orthotopic livertransplantation model in mice and provied experimental animal data for clinicalapplication.
     Methods The donor portal vein and hepatic vein are anastomosed with Cuff andsutrue technique respectively. The donor bile duct is implanted into recipientduodenum.
     Results The operation time of harvesting donors liver and anhepatic phase andrecipient were (30士3) min, (6士1) min and (58士5) min. The model successrate was 96 %,and the 4-week survival was 88 %.Conclusions The animal model was stable with high success-rate and can be used forthe study of auxiliary partial orthotopic liver transplantation.
     Part II Experiment I Reproduction and genotypeidentilfcation of Atp7b-/- mouse and its disorder of copper metabolism
     Objective To explore the reproduction and genotype identification of Atp7b-/- mouseand its disorder of copper metabolism.
     Methods The heterozygous mice were used for breeding, and the genotypeidentification of offspring was used by PCR. Copper contents were determined byatomic absorption spectrometry and HE staining was made for examination ofhistopathological change.
     Results The analysis of genotype indentification fit the Mendel's laws. HepaticAcopper of Atp7b-/- mice were about 25 times more than wildtype, but serum copperincreased and peaked at 20 week old and were twice more than wildtype. At 20 weekold, hepatocellular necrosis, fibrosis and nodules were detected in almost all theAtp7b-/- mice. Conclusions The Atp7b-/- mice could be inherited stably, and their had significant hepatic histopathological change that can be an ideal experimental animal of Wilson's disease.
     PartⅡExperimentⅡExperimental study on auxiliary partial orthotopic liver transplantation for Wilson's disease
     Objective To evaluate the treatment effectiveness of auxiliary partial orthotopic liver transplantation for Wilson's disease.
     Methods Auxiliary partial orthotopic liver transplantations were performed at 8 and 20 weeks old and the Left lateral lobe was the donor liver which accounts for 38% of the total recipient liver. Atp7b-/- mice were recipients, and Atp7b+/+ mice were donors. The survival and index of copper metabolism and liver function were observed after operation.
     Results The postoperative survival of 8 and 20 weeks time point were 92% and 85% respectively. Serum copper, remanent liver copper, serum ceruloplasmin activity and liver function were improved postoperatively, and in 8 weeks time point kidney copper and brain copper content decreased after operation, meanwhile the pathological changes of remanent liver was slighter than control; in 20 weeks time point, the donor liver proliferated and the remanent liver atrophied after operation, and the smaller donor liver (19% of total recipient liver) could also corrected the disorder of copper metabolism as same as OLT, but had lower surgical risk.
     Conclusions Left lateral lobe auxiliary partial orthotopic liver transplantation could take the place of orthotopic total liver transplantation for Wilson's disease, and early transplantation performed, the pathological process of remanent liver delayed and copper deposition in other ograns decreased. However, the minimum volume of liver meet the body's copper metabolic needs still needed to be further studied.
引文
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