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摘要: 自20世纪60年代以来,单纯冷保存一直是临床肝脏保存的主要模式。但供肝短缺,扩大标准供肝应用增加,对供肝保存也提出了更高的要求。近年来,肝脏机械灌注相关研究日益成熟,相关设备开发也越加完善,有望成为供肝保存与修复的有效手段。目前研究较多的机械灌注主要包括低温机械灌注、低温氧合机械灌注和常温机械灌注。经动物实验证明,机械灌注可以有效地挽救部分边缘供肝,减轻缺血-再灌注损伤,促进移植肝功能恢复,且灌注液中生化指标、胆汁量等均可为供肝质量评估提供客观指标。近两三年,在欧美地区也开展了临床应用,结果令人振奋,机械灌注对“不理想”的边缘供肝的确有修复作用。目前临床应用的病例还较少,欧洲数个移植中心已经拟开展相关的多中心研究。尽管机械灌注的前景乐观,但仍存在一些问题,包括应用指征、灌注参数设置、灌注液的选择等仍未达成统一,尚需大量的临床实践进行探索,其效果也需长期观察进一步验证。机械灌注不仅是一种理想的保存和修复手段,同时为药物治疗、基因干预等手段提供了平台。理想的机械灌注可以实现“个体化”保存,最大程度地保存、修复供肝。期待这一技术尽早成熟,真正服务于临床。
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