胃去门静脉循环断流术对肝前型门静脉高压犬胃黏膜及微循环血管超微结构的影响  

Effect of de-splanehnic circulation of the stomach on ultramicrostructure of gastric mucosa and submucosal mierocirculation in prehepatic portal hypertensive canine models

作　　者：王亮[1] 李宇[1] 牛兆建[1] 周岩冰[1] 

机构地区：[1]青岛大学医学院附属医院普外科,山东省266003

出　　处：《中华普通外科杂志》2011年第9期732-735,共4页Chinese Journal of General Surgery

摘　　要：目的观察胃去门静脉循环断流术（de-splanchnic circulation of the stomach，DSCS）对肝前型门静脉高压犬胃黏膜及黏膜下微循环血管超微结构的影响。方法将12只成年杂种犬按照“李宗芳法”（门静脉缩窄一半，丝线引起门静脉慢性血栓形成）制作犬肝前型门静脉高压食管静脉曲张模型，并于建模后4周造影检查侧支循环及曲张静脉形成情况。成模后随机分为两组，分别行贲门周围血管离断术和DSCS手术，于开腹后、手术后即刻及术后4周末测定食管曲张静脉压力，手术前、手术后4周末测定肝功能指标。术后4周末取胃组织进行透射电镜观察。结果DSCS手术组食管曲张静脉压力由术前的（22．1±0．9）cmH2O降至术后4周的（17．8±0．4）cmH2O，差异有统计学意义（P〈0．01）。手术前后肝功能指标变化不明显（P〉0．05）。超微结构显示贲门周围血管离断术组胃黏膜上皮细胞微绒毛断裂、脱落，微绒毛明显减少，黏膜下微静脉内皮细胞基膜厚薄不均且不连续，内皮细胞间隙可见明显红细胞聚集；而DSCS组胃黏膜上皮细胞微绒毛排列较整齐，断裂少见，黏膜下微静脉内皮细胞未见明显异常。结论DSCS手术可降低肝前型门静脉高压犬食管曲张静脉压力，改善胃黏膜及黏膜下微循环血管超微结构。Objective To evaluate the effect of de-splanchnic circulation of the stomach （DSCS） on ultramicrostrueture of gastric mucosa and submueosal microcirculation in prehepatic portal hypertensive canine models. Methods Twelve prehepatic portal hypertensive canine models were established by half constriction and silk line chronic embolization of the portal vein. The esophageal varices and collateral circulation were observed by venography after 4 weeks. Dogs with established model were divided into pericardial devascularization group and DSCS group randomly. Esophageal variceal pressure （VP） was measured when the abdoman was open immediately before the abdoman was closed and 4 weeks after the operation respectively. The liver function was also tested preoperatively and 4 weeks postoperatively. The ultrastructure of gastric mucosa and submucosal microcireulation was observed by transmission electron microscope. Results The VP decreased significandy from （22. 1 ± 0.9） cm H2O to （17.8 ±0. 4） cm H2O after DSCS （ P 〈 0.01 ）. There were no obvious different ehanges in the liver function preoperatively and postoperatively （ P 〉 0. 05 ） in pericardial devascularization group. The microvillus of gastric epithelium cells were interrupted and fell off and that microvillus significantly reduced. Moreover, it was also shown that the basal lamina of submucosal veinule endothelial cells were uneven thick and discontinuous and that red blood cells could be obviously gathered in the endothelial cells interspace. While there were less severe damages in the gastric musosa epithelia and submucosal venule endothelial cells in DSCS group. Conclusions DSCS procedure can significantly decrease espophageal variceal pressure and improve the uhramicrostrueture of gastric mucosa and submucosal mieroeirculation in canine models with prehepatic portal hypertension.

关 键 词：高血压 门静脉 微循环 动物模型 外科手术 

分 类 号：R657.3[医药卫生—外科学]