生长抑素对猪小体积肝移植术后门静脉压力梯度及供肝功能的影响  

The early effects of somatostatin on portal pressure gradient and the liver function of small-for-size liver grafts in pigs

作　　者：司马辉[1] 付雍[1] 张海斌[1] 朱楠[1] 赵文超[1] 杨宁[1] 杨广顺[1] 

机构地区：[1]第二军医大学附属东方肝胆外科医院肝外五科,上海200438

出　　处：《中华临床医师杂志（电子版）》2011年第14期4141-4147,共7页Chinese Journal of Clinicians(Electronic Edition)

基　　金：上海市科委医学引导项目(10411963200)

摘　　要：目的探讨生长抑素(SST-14)对猪小体积肝移植术后早期门静脉压力梯度(PPG)的影响及其对供肝功能的保护作用。方法 18对巴马小型猪,体重25~30 kg,随机分为全肝移植对照组4例、30%小体积肝移植组(小肝NS组)7例和30%小体积肝移植+SST干预组(小肝SST组)7例,各组均在非静脉转流条件下行肝移植术;SST-14干预方案:受体门静脉开放前3 min团注125μg,然后以5μg.kg-1.h-1持续给药24 h,小肝NS组以等量生理盐水作为对照。观察比较各组受体7 d累积存活率,再灌注后2 h及术后第1、2、3、5、7天肝肾及凝血功能变化,水柱法经门静脉和下腔静脉测压并计算术中及术后7 d内PPG值的变化,并比较再灌注后2 h各组移植肝病理学改变。结果小肝SST组供肝7 d累积存活率较小肝NS组明显增加(85.7%vs.42.9%),但由于例数较少,差异尚无统计学意义(P=0.0747);与全肝对照组比较,小肝NS组术后总胆红素(TBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)水平均显著升高,凝血酶原时间(PT)明显延长,至术后第5天,TBIL和PT值差异仍有统计学意义(P<0.05)。与小...Objective To investigate the early effect of somatostatin(SST) on portal pressure gradient(PPG) and the liver function of small-for-size(SFS) liver grafts in pigs.Methods 18 pairs of Ba-Ma miniature pigs were randomly assigned into three groups:the whole liver graft group(n=4),transplanted with 100% liver;SFS+NS group(n=7),transplanted with 30% liver with normal saline as control;SFS+SST group(n=7),transplanted with 30% liver with SST-14 administered as following method:bolus infusion via peripherial veins 3 minutes just before portal reperfusion followed by continous infusion at 5 μg·kg-1·h-1 for 24 hours.All the grafts were transplanted without venovenous bypass.All recipients were followed for 7 days with obtaining daily serum for liver function exam.The 7-day accumulate survival rate were calculated by Kaplan-Meier.The kinesis of PPG and pathological findings at 2 hours after reperfusion were further evaluated.Results 7-day accumulative survival rate in SFS+SST group was higher than SFS+NS group(85.7% vs.42.9%) but with no significance(P>0.05,Log-rank test).Compared to SFS+NS group,the ALT,AST,TBIL and PT in SFS+SST group were significantly decreased(P<0.05) and almost recovered on postoperative day(POD) 5.Pathological findings showed severe injury in the centrilobular and portal area in the SFS+NS group as early as 2 hours after reperfusion,whereas in SFS+SST group,it was mild.The values of PPG in SFS+NS group were significantly higher than the whole liver group(P<0.01) with two crest values at 2 hours after reperfusion and on POD 1,whereas in SFS+SST group,they were significantly decreased(P<0.01) with peak at 5 minutes post-reperfusion and thereafter downward to baseline on POD 3.Conclusions SST-14 can improve the liver function and survival rate of SFS graft in pigs by decreasing the persistent higher PPG at the early period of SFS liver transplantation.

关 键 词：生长抑素 肝移植 猪 小肝综合征 门静脉压力梯度 

分 类 号：R657.3[医药卫生—外科学]