广泛肝切除联合肝固有动脉切除对正常大鼠及梗阻性黄疸大鼠的影响  

Extended hepatectomy with hepatic artery resection in obstructive jaundice rats

作　　者：李斌[1] 张友磊[1] 李东[2] 章意亮[3] 高春芳[4] 许强芝[5] 倪灿荣[6] 侯元凯[1] 王义[1] 

机构地区：[1]第二军医大学附属东方肝胆外科医院肝外二科,上海200438 [2]第二军医大学生理学教研室 [3]第二军医大学遗传学教研室 [4]第二军医大学附属东方肝胆外科医院医学检验中心,上海200438 [5]第二军医大学生化与分子生物学教研室 [6]第二军医大学附属长海医院病理科

出　　处：《中华普通外科杂志》2008年第11期872-876,共5页Chinese Journal of General Surgery

摘　　要：目的探索在正常及高胆红素血症情况下，大鼠70％肝切除联合肝固有动脉切除对肝功能、肝细胞能量代谢以及肝再生和细胞凋亡的影响。方法雄性成年SD大鼠133只，将其中40只分为2组，每组20只，均行胆总管-十二指肠插管桥接，同时行70％肝切除或70％肝切除联合肝固有动脉切除。另87只行胆总管结扎制备梗阻性黄疸模型。5d后手术分为70％联合肝切除胆肠再通内引流组，及70％肝切除联合肝固有动脉切除、胆肠再通内引流2组。动态观察术后24h、72h、7d肝功能和肝细胞能量代谢、肝组织HGF和bcl-2 mRNA含量及其蛋白表达、肝细胞增殖指数和凋亡指数的变化，并统计各组死亡率。另取6只作为假手术组，测定术后0h肝功能和肝细胞能量指标。结果正常大鼠能够耐受70％肝切除联合肝动脉切除，术后肝细胞能量代谢和肝功能迅速恢复正常，肝再生良好。高胆红素血症时，大鼠术后肝再生受抑制，细胞凋亡增多。较之70％肝切除组，70％肝切除联合肝固有动脉切除组对肝细胞能量代谢的影响更为显著，术后肝功能恶化，肝组织HGF和Bcl-2 mRNA含量显著减少，肝再生明显受抑制，细胞凋亡增多，死亡率显著增高（P〈0．05）。结论正常大鼠70％肝切除联合肝动脉切除术后肝再生不受影响，高胆红素血症时，70％肝切除联合肝动脉切除的大鼠死亡率高，因此术前引流减黄应是必要的措施。Objective To study liver function, hepatic energy metabolism, regeneration and apoptosis in obstructive jaundiced or normal liver after 70% partial hepatectomy （PH） with hepatic artery resection （HAR） in rats. Methods In this study, 133 male SD rats were enrolled, 6 rats were in sham operation group, 20 rats underwent choledochoduodenostomy after 70% PH and 20 rats did 70%- PH, choledochoduodenostomy plus HAR. The remaining 87 rats 5 days after common bile duct ligation （CBDL） were randomized into two groups： 70% PH with choledochoduodenostomy, and 70% PH with choledochoduodenostomy plus HAR. Serum TB, ALT, ALB and ALP; tissue of hepatic HGF, bcl-2 mRNA and protein expression; ATP, ADP and AMP in hepatic tissues; hepatocyte proliferation/ apoptosis index were observed postoperatively （24 h, 72 h and 7 d）. Mortality was calculated. Results Rats without obstructive jaundice could tolerate 70% PH plus HAR with good liver regeneration. Compared with other groups, the serum liver function index ; ATP content and EC value ; HGF,bcl-2 mRNA content of liver tissue and the hepatocyte proliferation/apoptosis index in 70% PH with HAR group significantly aggravated and the mortality significantly increased in obstructive jaundice rats （ P 〈 0. 05 ）. Conclusions （ 1 ） The liver regeneration and apoptosis were not significantly influenced in normal rats undergoing 70% PH and 70% PH with HAR, moreover hepatocyte energy metabolism and liver function recovered rapidly in both groups. （2） With the existence of severe bilirubinemia, 70% PH with HAR caused an increased mortality suggesting a rationale for a preoperative bilirubin reducing procedures before a major surgery in malignant obstructive jaundice.

关 键 词：黄疸 阻塞性 大鼠 高胆红素血症 肝切除术 

分 类 号：R686[医药卫生—骨科学]