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目的观察猪活体肾移植手术中腹腔镜手术对移植肾缺血再灌注损伤的影响。方法用猪同种肾移植模型(白色小型猪CEMP-Ⅲ黑色小型猪CEMP-Ⅰ),分腹腔镜组和开放手术组活体取肾。移植后1、3 d观察移植肾组织学分析了解缺血再灌注损伤的程度,实时荧光定量聚合酶链反应(PCR)检测TLR4(Toll-like receptor)mRNA的表达了解导致缺血再灌注损伤差异的机制。结果组织学分析发现移植后1 d两组移植肾以肾小管浊肿为主,移植后3 d腹腔镜组移植肾肾小管多见片状坏死,而开放手术组仅见肾小管浊肿和局灶性坏死;检测移植肾中TLR4 mRNA表达,发现移植后第1天两组TLR4 mRNA表达指数差异无统计学意义(11.93±3.66比12.46±2.60,P>0.05),移植后第3天两组TLR4 mRNA表达指数差异有统计学意义(30.16±6.19比61.53±9.47,P<0.01)。结论腹腔镜活体取肾手术中CO_2气腹引起腹内压增加影响供肾血流,导致早期移植肾有加重缺血再灌注损伤的风险,TLR4表达增加可能发挥重要作用。
Objective To observe the effect of laparoscopic surgery on renal ischemia-reperfusion injury in porcine renal transplant recipients. Methods Pig kidney allograft model (white miniature pig CEMP-Ⅲ black miniature pig CEMP-Ⅰ) was divided into two groups: laparoscopic group and open surgery group. The rats were sacrificed at 1 and 3 days after transplantation to observe the extent of ischemia-reperfusion injury. The expression of TLR4 mRNA was detected by real-time fluorescence quantitative polymerase chain reaction (PCR) to find out the difference of ischemia-reperfusion injury Mechanisms. Results Histological analysis showed that renal tubules were mainly located on the first day after transplantation in rats. Tubular necrosis was found on the 3rd day after transplantation in the laparoscopic group, but only in the open group The level of TLR4 mRNA expression in the two groups was not statistically significant (11.93 ± 3.66 vs 12.46 ± 2.60, P> 0.05). On the third day after transplantation, the expression of TLR4 mRNA The difference of mRNA expression index was statistically significant (30.16 ± 6.19 vs 61.53 ± 9.47, P <0.01). Conclusions The increase of intra-abdominal pressure caused by the pneumoperitoneum of CO_2 pneumoperitoneum during laparoscopic surgery may lead to the increased risk of ischemia-reperfusion injury. The increased expression of TLR4 may play an important role.