肠腔分流条件下巴马小型猪缺血再灌注肝功及病理变化  

Changes of liver function and histopathology during hepatic ischemia-reperfusion with meso-caval shunt in swine

作　　者：陈继业[1] 马正伟[1] 李昆[1] 郑平[1] 董家鸿[1] 

机构地区：[1]第三军医大学西南医院全军肝胆外科研究所,400038

出　　处：《消化外科》2005年第4期279-282,共4页Journal of Digestive Surgery

基　　金：国家杰出青年科学基金海外青年合作研究基金资助(No.30228030);国家自然科学基金青年科学基金项目资助(No.30400436)

摘　　要：目的探讨肝缺血再灌注过程中肝功能及病理变化规律。方法将18头正常小型猪随机分为A组(入肝血流阻断90min)、B组(入肝血流阻断100min),对照观察两组动物在缺血前、复流前、复流1h及术后各时相点ALT、AST及肝组织病理的变化情况。结果(1)A组长期存活率为100%,B组长期存活率为44.4%;(2)两组动物于缺血及复流1hALT水平变化较术前无明显变化(P>0.05),至术后2、3d均显著高于术前水平(P<0.05),术后4d与术前无显著差异(P>0.05),术后2、3d时B组水平均显著高于A组(P<0.05);(3)两组动物于复流1h时AST水平达到峰值(P<0.05),此后AST水平逐渐下降,到术后3d与术前无显著性差异(P>0.05),复流1h,术后1、2d时B组水平显著高于A组(P<0.05);(4)两组动物肝组织病变随着缺血时间的延长而更加严重,在复流1h时肝组织损伤最为严重,随后肝组织损伤逐渐减轻,存活动物于术后4d肝组织结构基本恢复正常,死亡动物尸检见肝组织大片溶解坏死;(5)对比ALT、AST与肝组织病理学变化的关系可以看到,在肝IR过程中,ALT水平变化与肝组织变化趋势不一致,而AST水平变化与肝组织病理改变情况基本一致。结论(1)在长时间缺血过程中如发现肝组织出现灶性坏死、细胞广泛气球样变、脂肪变性将提示组织损伤难以恢复,动物难以耐受肝缺血再灌注损伤;(2)在肝脏缺血过程中检测血清ALT、AST并不能用于判断肝缺血再灌注损伤的预后情况,但再灌注过程中血清AST水平能较好的反映肝组织的受损程度。Objective To investigat the time-course changes of liver function and histopathology during hepatic ischemia-reperfusion. Methods 18 Bama swines were randomly divided into two groups with 9 animals in each group and the changes of liver function and histopathology were observed. (Results) (1) The survival rate in group A and B was 100% and 44.4%, respectively. (2) Compared with the pre-ischemia, the ALT levels in two groups on postoperative 2 d and 3 d were significantly increased (P<0.05). On postoperative 4 d, the ALT recovered to normal level (P>0.05). ALT level in group B was significantly higher than in group A on postoperative 2 d and 3 d (P<0.05). (3) AST levels in two groups reached peak at 1h after reperfusion (P<0.05), and recovered to normal level on postoperative 3 d (P>0.05). AST level in group B was significantly higher than in group A at 1h after reperfusion and on postoperative 1 d and 2 d (P<0.05). (4) The hepatic tissue injury was the most severe at 1 h after reperfusion and recovered to normal in group A on postoperative 4 d, however, hepatic necrosis was found in swines that were dead in group B. Conclusions (1) The changes that focal necrosis, massive ballooning degeneration and fatty degeneration occure after ischemia may indicate that the animal can not tolerate the IR injury. (2) In the hepatic ischemia-reperfusion course, the determination of ALT and AST level are not valuable in predicting the survival, however, AST is the better index which can reflect the degree of the hepatic IR injury.

关 键 词：肝脏 缺血再灌注 肝功能 病理 

分 类 号：R657.3[医药卫生—外科学]