热缺血对大鼠肝移植术后胆管周围血管丛的影响  

Effect of warm ischemia injury on peribiliary vascular plexus in rats after liver transplantation

作　　者：艾秋宝[1] 何谦[1] 张诚华[1] 张玉君[2] 

机构地区：[1]中国人民解放军第180医院普通外科,南京军区肝移植中心,福建泉州362000 [2]第三军医大学西南医院全军肝胆外科研究所,重庆400038

出　　处：《第三军医大学学报》2010年第19期2062-2065,共4页Journal of Third Military Medical University

基　　金：全军医学科研"十一五"计划面上项目(06MB153);南京军区医药卫生科研项目重点课题(09Z022)~~

摘　　要：目的初步探讨供肝热缺血损伤对大鼠肝移植术后胆管周围血管丛的影响。方法 108只受体SD大鼠平均分为假手术组(正常组)、无热缺血组(对照组)及热缺血10min组(实验组)。分别于术后第1、3、7、14天取9只大鼠处死,检测各组血清碱性磷酸酶(ALP)、谷氨酰转肽酶(GGT)、直接胆红素(DBIL)、间接胆红素(IBIL)。另取肝组织行石蜡切片,分别以HE染色和纤维素染色观察移植肝胆管周围血管丛及胆管结构的形态学改变。电镜检测各组各时相点胆管上皮细胞及胆管周围血管丛血管内皮细胞超微结构。结果实验组术后各时相点血清胆道酶谱和胆红素较相应时相点的对照组和正常组显著升高(P<0.05),恢复至正常的时间延迟;实验组HE和纤维素染色可见术后胆管周围血管丛损伤及胆管损伤较对照组及正常组严重,且实验组胆管周围血管丛内观察到微血栓形成;电镜下可见实验组术后早期血管内皮细胞损伤严重,且胆管上皮细胞出现缺血缺氧性改变。结论热缺血再灌注损伤可致胆管周围血管丛损伤及胆管上皮细胞缺血缺氧性改变,可能是肝移植术后缺血型胆管病变和一过性肝内胆汁淤积的重要原因。Objective To study the effect of graft warm ischemia injury on peribiliary vascular plexus in rats after liver transplantation.Methods One hundred and eight receptor SD rats were divided into sham operation group（normal group）,no warm ischemia injury group（control group）,10-minute warm ischemia injury group（experimental group）,36 rats in each group.Nine rats in each group were killed on days 1,3,7 and 14,respectively,after operation.ALP,GGT,DBIL and IBIL in each group were detected.Liver tissue sections were stained with HE and cellulose to observe changes in morphology of peribiliary vascular plexus and structure of bile duct.Ultra-structures of bile duct epithelium and vascular endothelial cells of peribiliary vascular plexus were observed under electron microscope.Results The serum ALP,GGT,DBIL and IBIL levels were significantly higher in experimental group than in control and normal groups all time points after operation（P 0.05） and restored to the normal was later.HE and cellulose staining showed that the damage of peribiliary vascular plexus and bile duct was severer in experimental group than in control and normal groups after operation.Micro-thrombosis was observed in peribiliary vascular plexus of experimental group after operation.Electron microscopy showed severe damage of vascular endothelial cells and hypoxic-ischemic changes in bile duct epithelial cells in experimental group after operation.Conclusion Warm ischemiareperfusion injury can lead to damage of peribiliary vascular plexus and hypoxic-ischemic changes in bile duct epithelial cells after liver transplantation,which may be an important reason for ischemic biliary lesion and transient intrahepatic cholestasis after liver transplantation.

关 键 词：肝移植 热缺血损伤 胆管周围血管丛 微循环 

分 类 号：R657.3[医药卫生—外科学] R332.12[医药卫生—临床医学]