目的 探讨原位肝移植术中常见的血管整形方法与临床效果。方法 根据肝脏移植的不同术式及供、受体血管之间的差异，对供或/和受体的肝上下腔静脉、门静脉、肝动脉进行必要的整形。结果 共施行肝上下腔静脉整形139例次，门静脉整形2例，术后均未发生相关并发症，肝动脉整形9例，术后1例发生肝动脉栓塞，需再次肝移植。结论 血管整形为肝移植手术技术中的重要环节，术前对供、受体各血管的准确评估，精细的血管整形技术是保证肝移植手术成功的关键。

目的 探讨不同热缺血时间条件下，无心跳供体（NHBD）的供肝质量与耐受热缺血的安全时限。方法 实验动物大鼠按供肝热缺血时间分别为0、10、15、20、30、45、60min，随机分为7组（n=12）。然后按各组条件分别作原位肝移植，观察肝移植术后各组组织形态、肝脏功能状态和能量代谢的恢复性变化，并统计生存时间。结果 在热缺血30min以内，肝组织损伤仍处在可复性阶段，复流后能逐渐恢复至正常的形态和功能。供肝热缺血损伤的时间与肝组织能量代谢功能的恢复及术后动物生存情况密切相关。供肝经受30min以内热缺血损伤，各组移植术后生存天数无明显差异。热缺血时间超过45min后，虽仍可获较短期的存活，但移植术后的长期存活时间明显缩短。热缺血60min以后，供肝已发生不可逆性损伤。结论 供肝组织三磷酸腺苷（ATP）含量、能荷（EC）水平和肝糖原含量、酶组织化学活性的变化以及移植术后上述指标恢复性的潜能可作为衡量供肝质量的重要标准。大鼠的供肝可以安全地耐受30min以内的热缺血。

目的 建立一个稳定的大鼠原位肝移植胆道外引流模型，为研究移植术后胆汁中的成分、细胞学及免疫学指标提供可能。方法 在Kamada方法的基础上，加以技术改进。肝上下腔静脉采用端端吻合法，门静脉及肝下下腔静脉采取袖套法吻合；胆总管内置引流管引至大鼠颈背部，外接引流袋。结果 共施行大鼠原位肝移植75次，24h动物存活率这9313%，1周动物存活为8616%。结论 该模型是研究肝移植术后胆汁成分、胆汁细胞学、免疫学指标变化的理想模型。细致的手术操作是模型成功的关键。

目的 观察大鼠肝脏热缺血损伤后组织学与超微结构的动态变化特点，探讨肝脏耐受热缺血的安全时限。方法 对42例不同热缺血时间条件下的大鼠肝脏标本进行组织学、组织化学与超微结构变化的动态观察。结果 光镜下，热缺血30min以后，开始出现肝细胞轻度水肿，灶性的空泡变性，并随热缺血时间的延长而加重，未见明显坏死。电镜下可见，线粒体肿胀尤为明显，但直至热缺血60min，大部分细胞仍为可逆性变化，仅少数细胞出现染色质边集、核碎裂和核溶解等。组织化学染色显示，热缺血30min 始出现肝糖原颗粒减少，并有逐渐加重趋势。琥珀酸脱氢酶、细胞色素氧化酶和三磷酸腺苷酶在热缺血60min后才发生明显的酶活性降低。结论 从组织学与超微结构方面证实，肝脏在单纯热缺血损伤时，缺血时间在60min以内，肝细胞损伤大多仍处在可复性阶段，仅部分缺血细胞发生不可复性的损伤。

AIM To discuss the effect of surgical procedures on the prognosis of patients of bile duct cancer and their indications. METHODS A retrospective analysis was made for 52 cases of hepat oportal bile duct cancer treated from January 1991 to December 1996. All the cases were classified according to the modified Bismuth-Corlettle system and received appropriate operation. Therapeutic effects were valuated on the basis of their survival rates, jaundice elimination, comfort index, operative mortality and complications. RESULTS Seventeen cases received surgical resection (32.7%). The urvival rate was 71.4%, 35.7% and 10.4% forone, two and three years respectively, and was 30%, 16.8% and 0% for those with drainage (P<0.05). The mortality rate was 6.0% for the drainage group and 5.9% for the resection group (P>0.05). Of the 17 resected patients, 8 (47.1%) had curative resection and 9 (52.9%) noncurative resection. Their mean survival time was 21.1 months and 7.5 months respectively (P<0.05). CONCLUSION Proper surgical procedure should be used on the basis of the local and general conditions of the patients, and aggressive resection with or without liver resection is a valid rocedure for the treatment of hepato portal bile duct cancer and can significantly improve the rognosisof patients.

AIM: To explore the dynamical changes of histology, histochemistry, energy metabolism, liver microcirculation, liver function and posttransplant survival of liver graft in rats under different warm ischemia times (WIT) and predict the maximum limitation of liver graft to warm ischemia. METHODS: According to WIT, the rats were randomized into 7 groups, with WIT of 0, 10, 15, 20, 30, 45, 60min, respectively. The recovery changes of above-mentioned indices were observed or measured after liver transplantation. The graft survival and postoperative complications in each subgroup were analyzed. RESULTS: Liver graft injury was reversible and gradually resumed normal structure and unction after reperfusion when WIT was less than 30min. In terms of graft survival, there was no ignificant difference between subgroups within 30min WIT. When WIT was prolonged to 45min, the recipients' long-term survival was severely insulted, and both function and histological structure of liver graft developed irreversible damage when WIT was prolonged to 60min. CONCLUSION: The resent study indicates that rat liver graft can be safely subjected to warm ischemia within 30min. The levels of ATP, energy charge, activities of glycogen, enzyme-histochemistry of liver graft and its recovery potency after reperfusion may serve as the important criteria to evaluate the quality of liver graft.

BACKGROUND: Since the 1990s, liver grafts from non-heart-beating donor (NHBD) have become an alternative because of the deficiency of grafts from heart-beating-do-nors (HBDs). Warm ischemia injury, however, directly influences the grafts'activity and functional recovery after operation. We investigated the microcirculatory change of liver graft at different warm ischemia time (WTT) in rats and determined the maximum limitation of liver graft to warm ischemia. METHODS: According to WIT, 120 rats divided ran-domly into 5 groups of 0, 15, 30, 45, 60, minutes respec-tively. The microcirculatory changes of their liver grafts were measured including serum level of hyaluronic acid (HA) and ultrastructural changes. After orthotopic liver transplantation (OLT), the recovery of microcirculation of the liver grafts after 24 hours, 48 hours and 3 days was ob-served. RESULTS: Microcirculatory changes and function of the liver grafts became normal after reperfusion when the WTT was less than 30 minutes. In the 45-minute WI group, part of blood sinusoids was full of cytoplasmic blebs stemming from the microvili of hepatocytes and hemocytes. The se-rum level of HA in each group after 45 minutes of WI re-covered after reperfusion. CONCLUSIONS: The microcirculatory change of rat liver graft is reversible when the WIT is less than 30 minutes: rat liver graft could be safely subject to warm ischemisa within 30 minutes. The maximal 45 minutes of WI can be tolera-ted by the microcirculatory function of liver graft. After 60 minutes of WI, irreversible disturbance of microcirculation may appear.

目的 探讨ABO配型对肝移植预后的影响。方法 回顾分析3例ABO血型不合的肝脏移植临床特点及治疗结果。结果 2例病人出现不可逆性排斥反应，分别于术后第18、20天死亡，1例病人未出现排斥反应，现已存活150天。结论 ABO配型不合对肝移植的预后可能有很大影响，目前仅限于在紧急状态下采用。

With advances in transplantation, multiorgan transplantation has become a treatment of choice for end-stage organ failure which can not be reversed with other modalities. In 1984, the first case of combined liver and kidney transplantation was introduced by Witts at Innsbruck University Hospital in a 30-year-old man with HBsAg positive cirrhosis. He survived more than 9 years [1]. Since then, an increasing number of such combined transplantation has been performed. But in Asia, this technique has not been put into clinical practice yet. We report such a case below.