脾切除在防治小肝综合征中的作用  

The Role of Splenectomy in the Prevention and Treatment of Small-for-size Syndrome

作　　者：吴刚[1] 孙会东[2] 杨蕾[1] 陈旭春[1] 程颖[1] 刘永锋[1] 

机构地区：[1]中国医科大学附属第一医院肝胆外科,沈阳110001 [2]山东省聊城市人民医院普外科,山东聊城252000

出　　处：《中国医科大学学报》2010年第2期108-111,共4页Journal of China Medical University

基　　金：辽宁省教育厅重点实验室科研基金资助项目(20060903)

摘　　要：目的探讨小肝综合征发生的内在机制及脾切除对小肝综合征发生的影响。方法建立大鼠小体积肝脏模型。脾切除组切除80%肝组织同时行脾切除,对照组仅行80%肝组织切除,假手术组仅肝脏游离,不做肝切除。检测术后门静脉压力、肝组织肿瘤坏死因子α(TNF-α)和增殖细胞核抗原(PCNA)mRNA和蛋白表达及髓过氧化物酶(MPO)活性、肝功能变化及小肝综合征发生率。结果肝切除后,对照组和假手术组比较门静脉压力明显增高,TNF-αmRNA表达和蛋白表达明显增强,MPO活性明显增高(P<0.05);脾切除组和对照组比较门静脉压力降低,TNF-αmRNA和蛋白表达量、MPO活性均降低(P<0.05),而PCNAmRNA和蛋白表达明显增强(P<0.05)。脾切除组肝功能损害及小肝综合征的发生率和对照组比较显著降低(P<0.05)。结论脾切除能够降低小体积肝脏的门静脉灌流和压力,减少促炎性细胞因子的表达和释放,减轻细胞损害,促进肝再生,降低小肝综合征的发生。Objective To explore the pathophysiologic mechanism of the development of a small-for-size syndrome （SFSS） and the role of splenectomy in the prevention and treatment of SFSS. Methods The rat models of sham-operation and 80% partial hepatectomy were established. Totally 144 mrs were randomly divided into 3 groups：1 ） splenectomy group：splenectomy was performed following 80% partial hepatectomy; 2） control group： 80% partial hepatectomy was performed ; 3 ） sham group ： no hepatectomy was performed. After the operation, we examined the portal venous pressures（PVP）,tumor necrosis factor （TNF-α） and proliferating cell nuclear antigen （PCNA） expression, the activity of myeloperoxidase （MPO） ,liver function and explored the prevalence of SFSS. Results Compared with the sham group, the PVP of the rats in the control group obviously elevated after hepatectomy,and the expression level of TNF-α and the activity of MPO in the hver significantly increased （P 〈 0.05）. Compared with the control group,the PVP,the expression of TNF-α in the hvers and the activity of MPO at the corresponding time points after hepatectomy in the splenectomy group significantly decreased, while the expression of PCNA increased （P 〈 0.05）. Administration of splenectomy resulted in a statistically significant decrease in aspartate transaminase （AST）,alanine transaminase（ALT） ,lactate dehydrogenase （LDH）,total bilirubin ,and the incidence of SFSS （P 〈 0.05 ）. Conclusion Splenectomy could alleviate liver injury, promote liver regeneration in small-for-size liver rats by reducing portal vein peffusion and pressure and the subsequent expression of proinflarnmatory mediators.

关 键 词：肝切除 肝移植 小肝综合征 脾切除 

分 类 号：R657.3[医药卫生—外科学]