大鼠阻塞性黄疸对肝叶切除的影响  

Impact of obstructive jaundice upon hepatectomy： experiment with rats

作　　者：孙杨忠[1] 耿小平[2] 

机构地区：[1]首都医科大学附属北京朝阳医院京西院区普外科,100043 [2]安徽医科大学第一附属医院普外科

出　　处：《中华医学杂志》2008年第14期998-1001,共4页National Medical Journal of China

摘　　要：目的探讨阻塞性黄疸程度、时间对大鼠肝叶切除体积的影响。方法120只Wistar大鼠结扎胆总管致阻塞性黄疸，分为8组，于胆总管结扎后第1、3、5、7天分别行30％、70％肝叶切除＋胆肠内引流术，比较各组术后肝功能、肝组织丙氨酸转氨酶及Na^＋K^＋ -ATP酶含量、病理改变、生存率，了解阻塞性黄疸程度、时间对不同体积肝切除的影响。结果结扎胆总管术后第3天，血清胆红素水平达高峰，1～8组术后生存率分别为20％、20％、100％、50％、30％、20％、0、0。结扎胆总管术后第1天行30％、70％肝叶切除＋胆肠内引流术，高死亡率非肝功能损害造成，而是在短时间难以耐受两次手术。结论行30％肝叶切除＋胆肠内引术是安全的；70％肝叶切除＋胆肠内引术风险极大。结扎胆总管术后第5、7天，难以耐受30％以上肝叶切除。Objective To investigate the impact of obstructive jaundice on hepatectomy. Methods 120 Wistar rats underwent ligation of the common bile duct to establish animal model of obstructive jaundice. On days 1 after ligation 20 rats underwent 30% hepatic resection ＋ choledochojejunostomy （ Group 1 ） and 20 rats underwent 70% hepatic resection ＋ choledochojejunostomy （Group 2） ; on day 3 after ligation 10 rats underwent 30% hepatic resection ＋ choledochojejunostomy （ Group 3 ） and 10 rats underwent 70% hepatic resection ＋ choledochojejunostomy （ Group 4 ） ; on day 5 20 rats underwent 30% hepatic resection ＋ choledochojejunostomy （Group 5 ） and 20 rats underwent 70% hepatic resection ＋ choledochojejunostomy （ Group 6） ; and on day 7 10 rats underwent 30% hepatic resection ＋ choledochojejunostomy （ Group 7 ） and 10 rats underwent 70% bepatic resection ＋ choledochojejunostomy （ Group 8 ）. The serum total protein, albumin, total bilirubin （TBIL）, direct bilirubin, and alanine transaminase （ALT） were detected. Then livers were taken out after the rats died or were killed, and the levels of ALT and Na^＋ K^＋ -ATPase were measure. Results The serum TBIL peaked on day 3. The survival rate after the operation of Groups 1, 2, 3, 4, 5, 6, 7, and 8 were 20% , 20%, 100% , 50%, 30% , 20% , 0, and 0 respectively. Conclusion （ 1 ） It is the too short a time between two operations, but not liver dysfunction, that is responsible for the high death rate in Groups 1 and 2. （2） 30% hepatic resection ＋ choledochojejunostomy performed 3 days after the ligation of common bile duct is safe with a survival rate of 100%. However, 70% hepatic resection ＋ choledochojejunostomy is dangerous in this time with a survival rate of 50% only. （ 3 ） 30% and 70% hepatic resection ＋ choledochojejunostomy performed 5 and 7 days after the ligation are very dangerous with a post-operational survival rate of zero.

关 键 词：胆汁淤积 胆红素 胆管 肝切除 

分 类 号：R686[医药卫生—骨科学]