探讨改良套管法构建小鼠颈部异位心脏移植模型的优越性与技术要点。

采用套管法(自制尾部带锚定柄套管)将供心升主动脉和肺动脉分别与受体颈总动脉和颈外静脉行端端吻合，观察手术成功率、手术时间和移植心脏存活时间，同时采用HE染色观察移植物病理改变。实验过程包括前期训练阶段和正式实验阶段，将正式实验小鼠分为同系对照组和同种异体组。采用Kaplan-Meier法绘制生存曲线，并采用log-rank检验进行比较。P<0.05为差异有统计学意义。

训练阶段共完成181例小鼠心脏移植手术，手术成功率22.1%(40/181)，手术时间逐步缩短。移植失败原因包括：供心与受体血管连接失败、受体血管游离破裂、血管套管外翻失败、静脉连接处淤血和术后慢性失血等。受体准备时间(25.2±1.0)min，供心获取时间(14.7±0.5)min，心脏移植时间(22.0±1.1)min，总手术时间(60.0±1.2)min。同系对照组和同种异体组均有1例小鼠在术后1 d因静脉连接处淤血导致心脏停跳，同种异体组另有1例小鼠术后因动脉吻合口漏血死亡。两组剩余18例受体小鼠移植心脏全部存活，手术成功比例为85.7%(18/21)。同种异体组小鼠移植心脏中位存活时间为7.0(5.0~7.0)d，同系对照组移植心脏中位存活时间均>100 d(除外1例术后1 d死亡)，两组小鼠移植心脏累积生存率差异有统计学意义(χ²＝14.83，P<0.05)。同系对照组移植物未观察到心肌细胞坏死或炎性细胞浸润，同种异体组可见大量淋巴细胞和单核细胞浸润，伴心肌水肿、出血坏死和微血管闭塞，呈典型急性排斥反应表现。

使用尾部带锚定柄套管，血管不易滑脱，显著降低手术难度，是建立小鼠颈部异位心脏移植模型的可行方法。

To investigate the superiority and key technical points of establishing a mouse cervical heterotopic heart transplantation model using the modified cuff technique.

The ascending aorta and pulmonary artery of the donor heart were anastomosed end-to-end to the recipient′s common carotid artery and external jugular vein, respectively, using a self-made tail-anchored cuff. Surgical success rate, operation time, and graft survival time were recorded. Pathological changes in the graft were assessed by HE staining. The experimental protocol included a pre-training phase and formal experimental phase, with mice in the formal phase divided into syngeneic control group and allogeneic transplant group. Survival curves were generated using the Kaplan-Meier method, and comparison was performed with the log-rank test. P<0.05 was considered statistically significant.

A total of 181 cases of mouse heterotopic heart transplantation were performed in the training phase, with a surgical success rate of 22.1% (40/181) and gradual reduction in operation time. Reasons for graft failure included failure of donor-recipient vascular connection, rupture during recipient vessel dissection, sleeve eversion technique failure, venous congestion at the anastomosis site, and postoperative chronic hemorrhage. The recipient preparation time, donor heart harvesting time, heart transplantation time, total operation time were (25.2±1.0) min, (14.7±0.5) min, (22.0±1.1) min and (60.0±1.2) min, respectively. One mouse died of venous congestion-induced cardiac arrest one day after the operation in both the syngeneic control group and allogeneic transplant group, and one mouse died of arterial anastomosis leakage in the allogeneic transplant group, yielding a success rate of 85.7% (18/21). The median graft survival time was 7.0 (5.0-7.0) d in the allogeneic transplant group and >100 d in the syngeneic control group (excepting 1 dead mouse). There was statistical significance for the cumulative survival rate of graft between the two groups (χ²=14.83, P<0.05). Histopathology revealed no myocyte necrosis or inflammatory infiltration in the syngeneic control group, whereas the allogeneic transplant group exhibited extensive lymphocytic and mononuclear cells infiltration, myocardial edema, hemorrhagic necrosis, and microvascular occlusion, consistent with acute rejection.

The application of cuff with tail-fixated shank prevents vascular slippage and significantly reduces operative difficulty, thereby establishing itself as the preferred methodology for developing heterotopic cervical heart transplantation models in mice.