大鼠移植肝胆道系统不同部位异质性对缺血再灌注损伤耐受性差异的比较  

Comparative study on ischemia-reperfusion injuries caused by heterogeneity of different positions of biliary system in liver graft in rats

作　　者：赵宏峰[1] 周杰[1] 王宇[1] 任旋磊[1] 

机构地区：[1]南方医科大学附属南方医院肝胆外科,广州510515

出　　处：《中华肝胆外科杂志》2010年第9期683-687,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的 研究胆道系统不同部位胆管上皮细胞的异质性以及胆管周围血管丛构筑形式的不同,对缺血再灌注损伤耐受性的差异.方法 30只SD大鼠随机分成3组,Ⅰ组（假手术组）,Ⅱ组（胆道缺血1 h再灌注1 h组）,Ⅲ组（胆道缺血1 h再灌注2 h组）.对肝门部胆管、胆总管近端及小叶间胆管的上皮细胞行凋亡（TUNEL法）检测、病理形态学评分和超微结构的定量分析.结果 Ⅱ组的细胞凋亡及病理形态评分在胆总管近端与小叶间胆管无统计学差异（P＞0.05）,但肝门部损伤较重（P＜0.05） 线粒体平均体积（V）及微绒毛面积密度（AMv）比较在肝门部最重,胆总管近端最轻（P＜0.05）.在Ⅲ组以上各指标都表现为肝门部最重,小叶间胆管次之,胆总管近端最轻（P＜0.05）.结论 胆管上皮细胞的异质性以及周围血管丛不同部位构筑形式的不同导致了胆道系统各部位损伤程度的差异.该结果为解释肝门部胆管狭窄高发率的临床表现提供了一定的实验基础.胆总管近端损伤最轻这一结果提示,在临床肝移植中,应尽量以胆总管近端作为最佳吻合部位.Objective To comparatively study the ischemia-reperfusion injuries caused by heterogeneity of different positions of the biliary system and different construction patterns of the peribiliary vascular plexus. Methods Thirty rats were randomly divided into 3 groups： Group Ⅰ , sham operated Group Ⅱ , 1h ischemia in biliary tract followed by 1h reperfusion Group Ⅲ, 1h ischemia in biliary tract followed by 2h reperfusion. TUNEL assay, pathomorphology score determination and ultrastructural quantitative analysis were performed on epithelium of the hilar bile duct, proximal common bile duct and interlobular bile duct. Results In groupⅡ , TUNEL assay and pathomorphology score showed no statistical difference between proximal common bile duct and interlobular bile duct （P〉0.05） but showed significant differences in the hilar bile duct（P〈0.05）. Mean volume （V） of mitochondria and area density of microvilli were obviously serious in the hilar bile duct but obviously slight in the proximal common bile duct（P〈0. 05）. In group Ⅲ, the results of the above detections showed that the most severe was in hilar bile duct, followed by the interlobular bile duct and proximal common bile duct（P〈0. 05）. Conclusion Different injuries in various parts of the biliary system are caused by heterogeneity of biliary epithelial cells and construction patterns of the peribiliary vascular plexus. It also provides the experimental basis to explain the higher incidences of hilar bile duct stricture. It could be taken as the best position when the bile duct is anastomosed.

关 键 词：肝移植 胆道 缺血再灌注损伤 胆管周围血管丛 大鼠 

分 类 号：R686[医药卫生—骨科学]