Effects Of Procurement Of Donor Liver And Anhepatic Phase Operation On Surgical Results And Learning Curve In Rat Liver Transplantation

Part 1 Procurement of donor liver in rat liver transplantation Objective:Use and compare the procurement methods of donor liver to improve the surgical method of rat liver transplantation.Methods:The donor liver is procured by traditional method and modified method respectively,and the operation time and the donor liver’s pathological results are compared.Results:The operation time of the traditional method and the modified method are about 60.8minutes and 38.3 minutes respectively,the surgery success rate are 80% and 100%respectively,and the modified method for the procurement of donor liver takes less time than the traditional method(P<0.05).The donor liver’s pathological section of the traditional method suggests that partial hepatic lobules are congested,while the modified method suggests that the morphology and structure of hepatic lobules are uniform.Conclusion:The sequence and method of ligament dissociation,vascular ligation and hepatic perfusion in the procurement of donor liver are crucial to the quality of donor liver.The modified method is only performed around the portal vein and the inferior vena cava,and then perfused along the abdominal aorta.The liver turnover operation is reduced,the procuring time of donor liver is shortened,and the quality of donor liver is improved.Part 2 Anhepatic phase operation in rat liver transplantation Objective:Use and compare various anhepatic phase operations to improve the surgical method of rat liver transplantation.Methods:Anesthesia,fluid infusion,abdominal aorta clamping and portosystemic shunt are used to compare and analyze the duration of anhepatic phase in rats after liver dissociation and vascular occlusion.Compare and analyze the operation time and surgery success rate in anhepatic phase that suprahepatic inferior vena cava anastomosis with magnetic ring,suture anastomosis of suprahepatic inferior vena cava,portal vein cannula using the retention line of before anhepatic phase,and portal vein cannula using the retention line of anhepatic phase.Results:The duration of anhepatic phase during chloral hydrate anesthesia,inhalation sevoflurane anesthesia,portal vein fluid infusion,abdominal aorta clamping,jugular vein indwelling needle rehydration,and splenic subcutaneous transposition are about 15.8minutes,23.6 minutes,27.1 minutes,29.9 minutes,33.4 minutes,and 43.6 minutes respectively.The duration of anhepatic phase in rats has been extended through the operations that inhalation sevoflurane anesthesia,fluid infusion,abdominal aorta clamping and portosystemic shunt(P<0.05).The operation time in anhepatic phase during suture anastomosis of suprahepatic inferior vena cava,suprahepatic inferior vena cava anastomosis with magnetic ring,portal vein cannula using the retention line of anhepatic phase,and portal vein cannula using the retention line of before anhepatic phase are about17.4 minutes,8.2 minutes,6.4 minutes,and 3.5 minutes respectively,and the surgery success rate are 80% 100% 80% and 90% respectively.The operation time in anhepatic phase of suprahepatic inferior vena cava anastomosis with magnetic ring is shorter than suture anastomosis(P<0.05).The operation time in anhepatic phase of portal vein cannula using the retention line of before anhepatic phase is shorter than portal vein cannula using the retention line of anhepatic phase(P<0.05).Conclusion:The duration of anhepatic phase in rats can be extended and the operations of anhepatic phase can be completed easily through the operations that anesthesia,fluid infusion,abdominal aorta clamping and portosystemic shunt.The operation time in anhepatic phase can be shorted and the surgery success rate can be improved through the operations that suprahepatic inferior vena cava anastomosis with magnetic ring and portal vein cannula using the retention line of before anhepatic phase Part 3 The surgical results and learning curve of traditional and modified methods in rat liver transplantation Objective:Conclude the modified method of rat liver transplantation,and compare and analyze the surgical results and learning curve of traditional and modified methods in rat liver transplantation.Methods:The two operators successfully performed 50 cases using the traditional and modified methods respectively since the first successful operation completion of rat liver transplantation.Record the number of the first operation success and total operation times of the two operators in detail,and use the Cumulative Sum method(CUSUM)to establish the learning curve.The donor liver procurement,donor liver repairment,recipient surgery time,surgery success rate,one-week survival rate and pathological results of the two methods are compared and analyzed.Results:In the traditional and modified methods,the serial number of the first successful operation are the 25 th and 14 th cases,and the total number of operation are the 117 th and81st cases.The time of donor liver procurement is about 60.8 minutes and 38.3 minutes,the time of donor liver repairment is about 14.8 minutes and 25.2 minutes,and the time of recipient surgery is about 77.8 minutes and 63.3 minutes respectively.In the traditional method,the time of donor liver procurement and recipient surgery is longer than that of the modified method(P<0.05),the time of donor liver repairment is shorter than that of the modified method(P<0.05).The surgery success rate is 42.7% and 61.7%,and one-week survival rate is 48% and 66% respectively.In the traditional method,the surgery success rate and one-week survival rate are lower than that of the modified method.The operators of the traditional and modified methods reach the inflection point of the learning curve at the 30 th and 21 st cases of the 50 successful surgeries respectively,and the goodness of fit in the learning curve of CUSUM method is 0.951 and 0.964.The liver’s pathological section of the traditional method suggests that partial hepatic lobules have structural disorder,while the modified method suggests that the morphology and structure of hepatic lobules are uniform.Conclusion:Through improving the operations of procurement of donor liver and anhepatic phase,the modified method of rat liver transplantation can reduce the operation time,decrease the operation difficulty,increase the surgery success rate and shorten the learning curve.Continuously modifying the operation method of rat liver transplantation will promote the learning and development of liver transplantation technology in rats,and basic research on diseases related to liver transplantation.