逆灌注对移植肝缺血再灌注损伤的影响  

Liver graft injury induced by ischemia and reperfusion secondary to retrograde reperfusion

作　　者：刘其雨[1,2] 李立[1,2] 李晓延[1,2] 陈刚[1,2] 赵英鹏[1,2] 白建华[1,2] 朱新锋[1,2] 

机构地区：[1]昆明市第一人民医院 [2]昆明医学院附属甘美医院肝胆外科,云南省昆明市650034

出　　处：《世界华人消化杂志》2011年第15期1550-1554,共5页World Chinese Journal of Digestology

基　　金：云南省自然科学基金资助项目;No.2008CD195;昆明市科技计划基金资助项目;No.08S100304-2~~

摘　　要：目的:探讨原位肝移植中经下腔静脉逆行灌注对移植肝缺血再灌注损伤的影响.方法:36例大鼠肝移植随机分为3组,每组12例.门静脉组即经门静脉顺行灌注,肝动脉+门静脉组即同时开放肝动脉及门静脉顺行灌注,下腔静脉组即先吻合下腔静脉后开放逆行灌注,然后吻合门静脉及肝动脉.分别检测术后1、6及24h的血清转氨酶、移植肝病理变化及肝细胞凋亡.结果:逆灌注组的肝酶学水平及肝细胞凋亡指数明显低于顺行灌注组,移植肝的病理变化亦轻于逆灌注组,而门静脉+肝动脉组肝组织病变最重,肝细胞凋亡指数最大.门静脉+肝动脉组血清转氨酶水平也最高,移植后24h,门静脉+肝动脉组与门静脉组及下腔静脉组比较,差异显著(2564.1U/L±410.3U/Lvs1801.6U/L±324.5U/L,968.4U/L±221.5U/L,P=0.003,0.000).结论:与传统的顺行灌注相比,经下腔静脉逆灌注可以减轻移植肝缺血再灌注损伤.AIM：To evaluate the influence of retrograde reperfusion on ischemia/reperfusion injury in a rat model of liver transplantation.METHODS：Thirty-six male Sprague-Dawley rats undergoing orthoptic liver transplantation were divided into three groups（n = 12 for each group）：group 1,antegrade reperfusion via the portal vein;group 2,antegrade reperfusion simultaneously via the portal vein and hepatic artery;group 3：retrograde reperfusion via the vena cava.Serum parameters were determined 1,6 and 24 h after operation.Liver samples were taken for histological assessment.Cell apoptotic index was determined.RESULTS：Rats of group 3 showed significantly lower serum level of aspartate aminotransferase compared to groups 1 and 2（968.4 U/L ± 221.5 U/L vs 1 801.6 U/L ± 324.5 U/L,2 564.1 U/L ± 410.3 U/L,P = 0.003,0.000）.Serum level of aspartate aminotransferase was significantly lower in group 1 than in group 2.The liver of rats of group 3 showed significantly less leukocytic infiltrates compared to groups 1 and group 2.The apoptotic index was lower in group 3 than in group 1 and 2.CONCLUSION：Retrograde reperfusion leads to a lower level of ischemia/reperfusion injury than antegrade reperfusion in rats undergoing liver transplantation.

关 键 词：肝移植 逆灌注 缺血再灌注损伤 凋亡 

分 类 号：R657.3[医药卫生—外科学]