本文選題：肝移植 + 血管灌注　； 參考：《天津理工大學》2017年碩士論文

【摘要】：肝臟是人體代謝的一種重要器官,肝衰竭會對人體的健康造成惡劣的影響。目前,對肝衰竭徹底治療的重要手段是肝臟移植手術(shù)。由于供肝來源少,導致可用的優(yōu)質(zhì)肝供體相對緊缺,使得醫(yī)療現(xiàn)場采用邊緣肝供體的可能性也越來越大,提高肝供體的質(zhì)量將變成關(guān)鍵問題。肝臟灌注是移植手術(shù)前清洗和保存環(huán)節(jié)中的核心,采用適宜的肝臟灌注方法是更好的清除異物和保護肝臟組織的保障,也能夠減少缺血或異常受力變化對其血管和器官組織造成損傷,同時有利于術(shù)后快速恢復(fù)。研究方法:本文基于恒流灌注方法存在的缺點和現(xiàn)階段缺乏醫(yī)用灌注液參數(shù)的研究基礎(chǔ)上,提出兩種全新的肝臟灌注方法,對稱式脈動流和非對稱式脈動流。通過研究灌注仿真過程中的動力學特性,闡明新的灌注方法的可行性。研究中首先構(gòu)建了一級直血管、一級狹窄直血管、一級狹窄彎曲血管、一級非平滑血管以及不同角度的分支血管模型,并給出管內(nèi)流體、管壁及流-固耦合控制方程。然后,基于雙向流-固耦合分析,將新提出的兩種肝臟灌注方法應(yīng)用到不同幾何形狀的三維彈性肝臟血管模型中進行血管灌注仿真,模擬血管壁的運動及灌注液在血管內(nèi)的流動。最后,分析肝臟血管灌注中動力學特性(主要包括流速、剪切力及血管變形等)的變化,并與恒流灌注的仿真數(shù)據(jù)進行對比,研究比較了不同幾何形狀的血管模型在灌注過程中其血管動力學特性的差異,說明本文提出的新的灌注方法的可行性。研究結(jié)果:采用多用途有限元仿真分析軟件ANSYS進行灌注仿真模擬,仿真結(jié)果清晰地顯示了血管內(nèi)的流體動力學行為。對某一種特定幾何形狀的血管模型分別采用對稱式脈動流、非對稱式脈動流和恒流的灌注方法進行灌注仿真時,血管內(nèi)灌注液的流速、血管變形和流-固耦合交界面剪切力的變化規(guī)律基本相同。在灌注液成功帶走異物的前提下,對稱式脈動流灌注時血管壁產(chǎn)生的變形要小于恒流灌注時血管壁產(chǎn)生的變形,即該灌注過程減弱了血管壁的徑向運動,降低了血管壁的變形帶來的肝臟血管組織損傷;采用非對稱式脈動流灌注時血管壁產(chǎn)生的變形均小于恒流灌注時血管壁產(chǎn)生的變形,而且第二非對稱式脈動流灌注時的血管變形小于第一非對稱式脈動流灌注時的變形。血管單位橫截面流過相同流量的灌注液時,不同幾何形狀的血管模型在不同灌注方法下的血管動力學特性不同,但對稱式脈動流的灌注仿真效果優(yōu)于其他灌注方法產(chǎn)生的結(jié)果。研究結(jié)論:研究結(jié)果表明,本文提出的新的灌注方法是可行的,研究不同肝臟灌注方法和血管幾何模型對灌注仿真過程中的動力學特性產(chǎn)生的影響,為臨床醫(yī)療改變灌注參數(shù)以改善肝供體質(zhì)量提供理論依據(jù)。
[Abstract]:The liver is an important organ for human metabolism, and liver failure will have a bad effect on the health of the human body. At present, liver transplantation is an important means of complete treatment for liver failure. Because of the lack of donor liver, the available high quality liver donor is relatively tight, and the possibility of using the marginal liver donor in the medical site is becoming more and more likely. The quality of the high liver donor will become a key problem. Liver perfusion is the core of cleaning and preservation before transplantation. The appropriate liver perfusion method is a better guarantee for removing foreign bodies and protecting liver tissue, and can also reduce the damage to blood vessels and organs by ischemia or abnormal stress changes, and is beneficial to the post operation. Fast recovery. Research methods: Based on the shortcomings of the constant current perfusion method and the lack of medical perfusion parameters at the present stage, two new liver perfusion methods, symmetrical pulsating flow and asymmetric pulsating flow are proposed in this paper. By studying the dynamic characteristics of the perfusion simulation, the feasibility of the new perfusion method is clarified. First, the first order straight vessel, first order narrow straight blood vessel, first order narrow curved vessel, first order non smooth blood vessel and different angle branch vessel model are constructed, and the internal fluid, tube wall and flow solid coupling control equation are given. Then, based on two-way flow solid coupling analysis, the new two kinds of liver perfusion methods are applied to not In the three-dimensional elastic liver vascular model of the same geometry, the blood vessel perfusion simulation is simulated, the movement of the blood vessel wall and the flow of the perfusion fluid in the blood vessel are simulated. Finally, the changes of the dynamic characteristics (including the flow velocity, shear force and blood vessel deformation, etc.) in the liver blood vessel perfusion are analyzed and compared with the simulation data of the constant flow perfusion, and the comparison is made to study the comparison. The difference of vascular dynamic characteristics of vascular models with different geometric shapes in the process of perfusion indicates the feasibility of the new method of perfusion proposed in this paper. The results of the study are: using the multi purpose finite element simulation analysis software ANSYS to simulate the perfusion simulation, and the simulation results clearly show the fluid dynamic behavior in the blood vessel. When the vascular models of specific geometry are symmetrical pulsation flow, asymmetric pulsating flow and constant flow perfusion method, the flow velocity of intravascular perfusion, vascular deformation and flow to solid coupling interface shear force are basically the same. Under the premise of successful removal of foreign objects, the symmetrical pulsation flow is carried out. The deformation of the vascular wall is less than that of the vascular wall during perfusion, that is, the perfusion process reduces the radial movement of the vascular wall and reduces the damage of the vascular tissue caused by the deformation of the vascular wall, and the deformation of the vascular wall produced by the asymmetric pulsation flow is smaller than that produced by the blood vessel wall during the constant flow perfusion. The vascular deformation of the second asymmetric pulsating flow is less than that of the first asymmetric pulsating flow. When the unit cross section of the vessel flows through the same flow of perfusion, the vascular dynamics of the vascular models of different geometric shapes are different under different perfusion methods, but the simulation effect of the perfusion of symmetrical pulsating flow The results show that the new perfusion method proposed in this paper is feasible, and the effects of different liver perfusion methods and vascular geometric models on the dynamic characteristics of perfusion simulation are studied, and the theory of changing perfusion parameters to improve the quality of liver donor in clinical medical treatment is provided. Basis.

【學位授予單位】：天津理工大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R657.3

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