磁压榨技术构建血管化肝内门体分流道治疗肝硬化门脉高压症的实验研究

The failure in vascularization of intrahepatic portosystemic shunt is crucial for unsatisfactory long-term shunt outcome after TIPS. Up to date, there is no effective method for constructing the vascularization of intrahepatic portosystemic shunt in the world. In our preliminary work, we found that vascularization could be observed in portacaval shunt using magnetic compression technique. According to this, we hypothesized that if intrahepatic portosystemic shunt could be realized by magnetic compression technique, vascularization of intrahepatic portosystemic shunt might be achieved. In this way, we could construct a micro invasive and functional surgical procedure for accomplishing intrahepatic portosystemic shunt. To verify the hypothesis, the work would be done as follows. First of all, in cirrhotic portal hypertension canine model, the target vascular, magnetic compression distance and surgical path for magnetic compression technique would be investigated in anatomy through 3D vascular reconstruction. At the same time, we would also research the quantitative relationship for magnetic force-time-histological outcome in liver. The design and manufacture of the magnet would be determined by both optimal magnetic force parameter and structure parameter, which were obtained through the quantitative relationship and magnetic compression distance. At last, we would attempt intrahepatic portosystemic shunt using magnetic compression technique in cirrhotic portal hypertension porcine model. The vascularization of intrahepatic portosystemic shunt would be tested through histology. We would also evaluate the long-term shunt outcome for this novel surgical procedure. By this work, we aimed to provide the theoretical base for the novel micro invasive intrahepatic portosystemic shunt.

肝内门体分体流道的非血管化，是TIPS术后分流道远期通畅率低的根本原因，目前国内外尚无有效实现肝内门体分流道血管化的方法。我们在既往研究中发现，利用磁压榨技术在进行门腔静脉磁力压榨后可实现血管吻合。基于此，我们提出如能将磁压榨技术用于肝内血管的压榨就有可能建立血管化的肝内门体分流道，以此来创立既微创又具有良好分流效果的肝内门体分流新术式。对此，本课题拟构建犬肝硬化门脉高压症模型，通过三维血管重建技术，从解剖学层面探索磁压榨目标血管、压榨间距和操作路径；同时，对肝硬化肝脏组织的磁力-时间-组织学效应之间的关系进行量化研究，并结合压榨间距，来设计压榨磁体的最佳磁力学参数和结构参数，指导磁体的设计和加工；最后，对模型动物实施磁压榨肝内门体分流术，组织学观察分流道血管化形成情况，并评价该术式对肝硬化门脉高压的长期分流效果。通过本研究将为建立一种新的微创化磁压榨肝内门体分流术提供理论依据。

肝硬化门脉高压症是消化系统常见疾病，经颈静脉肝内门体分流术是重要治疗手段。肝内门体分流道的非血管化是经颈静脉肝内门体分流术后远期通畅率低的根本原因。目前国内外尚无有效实现肝内门体分流道血管化的方法。项目组在前期研究中发现，利用磁压榨技术可实现血管吻合，吻合口内皮化形成良好。基于此，本项目组首次提出将磁压榨技术用于建立血管化肝内门体分流道的研究假设。研究结果表明：1）成功制备了比格犬肝硬化门脉高压症动物模型，并根据其肝静脉、门静脉解剖结构特点，自行设计加工了用于肝内门体分流的子母磁体，提出了子母磁体的双路径置入手术路径；2）在实验犬上成功实施了磁压榨肝内门体分流术，术后2-3周经颈静脉可顺利拔除子母磁体，肝内分流道建立，长期观察分流道通畅性良好。本项目首次将磁压榨技术用于介入操作下的血管重建，该项目的成功实施是对磁压榨技术的重要探索，有益于扩大磁压榨技术的人临床应用领域。在本项目研究成果基础上，进一步优化操作流程，该技术有望实现临床转化。