肠腔分流下巴马小型猪肝脏耐受入肝血流阻断的安全时限研究  

On tolerance limit for normothermic hepatic inflow occlusion by meso-caval shunt in Bama swines

作　　者：陈继业[1] 马正伟[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,全军肝移植重点实验室重庆400038

出　　处：《第三军医大学学报》2007年第4期342-345,共4页Journal of Third Military Medical University

基　　金：国家杰出青年科学基金海外青年合作研究基金(30228030);国家自然科学基金青年基金(30400436)~~

摘　　要：目的了解在肠腔分流条件下正常巴马小型猪肝脏耐受缺血的安全时限,为临床上阻断肝脏血流的时间及设计合理手术方案提供实验依据。方法将18只正常小型猪随机分为A组(肝血流阻断90min)、B组(肝血流阻断100min),在肠腔分流的条件下,观察2组动物的术后存活情况、入肝血流阻断前后,再灌注0、1h、1～5d时肝功能及组织病理改变。结果①A组动物长期存活率显著高于B组(100%与44.4%,P<0.05)。②2组动物ALT在术后2、3d显著升高,术后4d时与术前无显著差异,术后2、3d时B组显著高于A组;复流1h时2组AST水平达峰值,此后逐渐下降,术后3d与术前无显著性差异,复流1h、术后1、2d时B组AST显著高于A组;A组动物缺血时D-BIL、T-BIL显著升高,复流1h后降至正常水平,B组动物至术后5d才恢复正常水平,于复流前、复流1h、术后1、2、3、4d时B组动物D-BIL、T-BIL均显著高于A组。③2组动物缺血时肝组织损伤明显,复流1h时损伤进一步加重,A组及B组长期存活动物肝组织结构于术后4d恢复正常;与A组比较,B组肝组织损伤显著,坏死灶明显增多。结论避免门静脉淤滞条件下正常巴马小型猪常温耐受入肝血流阻断的安全时限可达90min。Objective To establish an animal model of hepatic inflow occlusion with meso-caval shunt in Bama swines so as to evaluate the tolerance limit of normothermic hepatic inflow occlusion. Methods Eighteen Bama swines were divided into group A in which the hepatic blood inflow was occluded for 90 min and group B in which the hepatic blood inflow was blocked for 100 min, The animal survival rate, the changes of liver function and histopathology were observed. Results The animal survival rate was significantly higher in group A than group B （ 100% vs 44.4%, P 〈 0. 05 ）. Compared with the pre-ischemia value, ALT levels in the two groups on the 2^nd and 3^rd day postoperatively were significantly increased. On the 4^th day postoperatively ALT recovered to normal level. ALT level was significantly higher in group B than group A on the 2^nd and 3^rd days post-operatively. AST in the two groups peaked at 1 h after reperfusion, and recovered to normal on the 3^rd day post-operatively. AST was significantly higher in group B than group A at 1 h after reperfusion and on the 1^st, and 2^nd days postoperatively. T-BIL and D-BIL levels in group A at ischemia 90 min were significantly higher than the pre-ischemia levels, and then decreased to the normal min of ischemia, and returned to normal on the 5^th day level. T-BIL, D-BIL levels in group B peaked after 100 postoperatively. T-BIL and D-BIL levels in group B were significantly higher than group A at the end of ischemia, 1 h after reperfusion and postoperative days 1 -4. Hepatic injury was severer at 1 h after reperfusion in both groups. The hepatic tissue recovered to normal in group A on the 4^th day postoperatively; however, hepatic necrosis was found in group B. Conclusion Ninety minutes is the tolerance limit for normothermic hepatic inflow occlusion in swine under conditions of meso-caval shunt.

关 键 词：肝脏 缺血再灌注 肝功 病理 耐受 

分 类 号：R-332[医药卫生] R364.12