门静脉、肝动脉同时灌注对供肝动脉缺血损伤的保护作用  

Protection from Hepatic Artery Ischemia with Hepatic Artery Bridge-Conduit in Liver Transplantation

作　　者：黎一鸣[1] 徐金锴[1] 吉鸿[1] 徐心[1] 侯崇智[1] 

机构地区：[1]西安交通大学第二医院普外科,西安710004

出　　处：《中国普外基础与临床杂志》2005年第5期473-476,479,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨肝移植门静脉再灌注过程中肝动脉缺血(hepaticarteryischemia,HAI)损伤的严重性和应用肝动脉桥式置管(hepaticarterybridge-conduit,HABC)技术实现门静脉、肝动脉同时灌注对这一损伤的保护作用。方法32只犬按随机数字表法随机均分为4组:正常对照组、HAI30min组、HAI2h组和HABC组。后三组分别建立犬自体原位肝脏移植模型,HABC组应用HABC技术使肝动脉、门静脉同时再灌注。术后取供肝组织与胆管组织电镜观察肝细胞和胆管上皮细胞病理学改变。分别应用硫代巴比妥酸法检测肝组织中丙二醛(MDA)浓度、黄嘌呤氧化酶法检测过氧化物歧化酶(SOD)活性、酶标记法检测肝细胞线粒体琥珀酸脱氢酶(SDH)活性。结果HAI30min即可见供肝肝细胞和胆管上皮细胞水肿、线粒体嵴减少,HAI2h其病理改变进一步加重,胆管上皮尤为明显,而HABC组则见肝细胞和胆管上皮细胞比较完整,胆管上皮绒毛丰富。HAI30min组和HAI2h组肝组织中MDA含量增加,分别为(1.652±0.222)nmol/mgprot和(2.379±0.526)nmol/mgprot,而SOD则降低至(11.15±3.9)U/mgprot和(9.47±3.4)U/mgprot,SDH活性则分别降低至0.362±0.019和0.281±0.029,与正常对照组比较差异有统计学意义(P<0.05,P<0.01);而HABC组MDA含量、SOD和SDH活性与正常对照组比较差异无统计学意义(P>0.05)。结论HABC技术的实施,可为临床肝移植中预防HAI损伤,减少肝移植术后并发症,特别是胆道并发症的发生提供有效的方法。Objective The injury induced by hepatic artery ischemia （HAl） in the liver transplantation procedure and the protective effects of using hepatic artery bridge-conduit （HABC） technique were studied. Methods Thirty-two dogs were randomly divided into 4 groups： control, HAl 30 min, HAl 2 h and HABC groups. We observed the pathological changes of hepatocytes and biliary tract tissues and the microstructure of chondriosome, which were based on the model of auto-orthotopic liver transplantation in dogs. Biochemical and spectrophotometric methods were used to evaluate the content of MDA and SOD, SDH activities in the graft liver tissue respectively. Results The pathologic and electrical microscopic changes of hepatocytes and epithelial cells of bile ducts were found in HAl 30 min and HAl 2 h groups,while the content of MDA increased to （1. 652±0. 222） nmol/mg prot and （2. 379±0. 526） nmol/mg prot, and SOD activity decreased to （11. 15±3. 9） U/mg prot and （9.47±3.4） U/mg prot. At the same time, SDH activity was also down-regulated to 0. 362±0. 019 and 0. 281±0. 029. Compared with control group, the differences were significant （P±0.05, P±0.01）. But these changes of functional index caused by HAl injury were not significant in HABC group. Conclusion The HABC technique can not only avoid HAl injury during operation but also alleviate the occurrence of complication after transplantation, especially the biliary tract complication.

关 键 词：肝动脉缺血 肝脏移植 缺血-再灌注损伤 肝动脉桥式置管 

分 类 号：R657.3[医药卫生—外科学]