大鼠入肝血流与半肝血流阻断下肝脏损伤的随机对照实验  

Comparison of total hepatic and hemihepatic blood inflow occlusion in rat:a prospective randomized trial

作　　者：杨健[1,2] 吴国长[1,3] 文天夫[1] 

机构地区：[1]四川大学华西医院普外科,四川成都610041 [2]四川省宜宾市第二人民医院普外科 [3]山东省烟台市毓璜顶医院腹部外科

出　　处：《四川医学》2011年第2期145-148,共4页Sichuan Medical Journal

基　　金：四川省卫生厅科研项目(编号:0040205301185)

摘　　要：目的采用大鼠入肝血流阻断(HT)和半肝血流阻断(HH)的缺血再灌注模型比较二者在生存率及生存时间、病理改变、肝细胞超微结构改变。方法健康SD大鼠60支随机分成6个组,每组10只大鼠,1、2、3为TH组,阻断时间别为30、45、60min;4、5、6为HH组,阻断时间分别为30、45、60min。再灌注时间均为30min,复流结束行肝左叶切除。观察指标包括大鼠生存率和生存时间,肝组织苏木精-伊红染色光镜下观察肝脏组织病理变化,透射电镜(TEM)下观察肝脏组织超微结构的变化。结果 HH组术后7d生存率明显高于TH组。不同缺血再灌注时间段的HH生存时间明显延长,(P<0.05)。TH和HH在不同缺血再灌注时间的生存时间统计学比较分别为0.055、0.000、0.000。TH和HH组苏木精-伊红染色病理改变没有统计学差异(P=0.484),但是,阻断时间越长,肝细胞损伤越大(P=0.002)。透射电镜表现包括线粒体肿胀、染色质边聚、窦状隙内皮细胞肿胀、窦状隙间隙增宽、胞桨脂变和凋亡小体形成。结论阻断时间在60min内,大鼠HH组生存率和生存时间优于TH组;TH与HH组肝组织苏木精-伊红染色病理学改变差异无统计学意义;阻断时间在60min以内,肝细胞没有发生不可逆的超微结构改变。Objective To compare the survival time and rate、pathological changes、the ultrastructure of liver cells between the total hepatic blood inflow occlusion group（TH）and the hemihepatic blood inflow occlusion group（HH）in a rat model.Methods Sixty male SD rats subjected to hepatic blood inflow occlusion were randomly assigned to TH or HH.The two ischemic-reperfusion groups included three different ischemia period：30 minutes,45 minutes and 60 minutes with 30 minutes reperfusion.After reperfusion,left liver resection was performed for pathologic determination.Liver injury was evaluated using rats survival rate and time、pathologic changes by hematoxylin and eosin（HE）staining、ultrastructural changes by transmission electron microscope（TEM）.Results Rats survival rate of postoperative day 7 in HH group was significantly higher than in TH group.HH was associated with better animal survival time compared with TH（P=0.00,P0.05）.Statisticaldifference was presented between TH and HH groups at different ischemia-reperfusion period with P value being 0.055,0.000,0.000,respectively.On the basis of statistical analysis,there were no differences on the examination of HE-stained tissue slides between HH and TH group（P=0.484）.However,the more time the occlusion was performed,the more injury of hepatocyte was present（P=0.002）.The characteristics under TEM included mitochondria seelling,margination of chromatin,endothelial cell swelling,dilated sinusoidal space,steatosis,apoptosis body.Conclusion The survival time and rate in HH group within 60 minutes in rats is superior to TH group.There are no pathological changes between two groups;Within 60 minutes of blood inflow occlusion,the ultrastructural changes of liver cells are reversible.

关 键 词：入肝血流阻断 半肝血流阻断 病理学 超微结构 

分 类 号：R657.3[医药卫生—外科学]