肝切除联合胆肠内引流对梗阻性黄疸大鼠的影响  

Influence of Hepatectomy Combined with Internal Biliary Drainage in Obstructive Jaundice Rats

作　　者：李斌[1] 刘辰[1] 易滨[1] 罗祥基[1] 高春芳[2] 许强芝[3] 于勇[1] 姜小清[1] 

机构地区：[1]第二军医大学附属东方肝胆外科医院胆道一科,上海200438 [2]第二军医大学附属东方肝胆外科医院实验诊断科,上海200438 [3]第二军医大学生化与分子生物学教研室,上海200438

出　　处：《中国普外基础与临床杂志》2011年第12期1271-1277,共7页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探索在高胆红素血症下,大鼠胆肠内引流联合肝切除对肝功能、肝细胞能量代谢以及肝细胞再生和凋亡的影响。方法雄性成年SD大鼠120只,其中6只大鼠作为假手术(SO)组;20只行70%肝切除,同时行胆总管-十二指肠插管桥接(70%PH组);另94只行胆总管结扎(CBDL)制备梗阻性黄疸模型,建模成功后5d时随机取6只动物作为CBDL组,余下的动物5d后行二次手术,再分为胆肠内引流再通组(BDO-RBF组,20只)、42%PH+BDO-RBF组(20只)及70%PH+BDO-RBF组(25只)。检测CBDL组5d时及二次手术后各组术后24h、72h及7d时肝功能和肝细胞能量代谢、肝组织肝细胞生长因子(HGF)和bcl-2mRNA含量及其蛋白表达、肝细胞增殖指数和凋亡指数的变化。SO组只测定术后0h肝功能和肝细胞能量指标。结果正常大鼠能够耐受70%肝切除,术后肝细胞能量代谢和肝功能迅速恢复正常,肝再生良好、细胞凋亡无明显增多。较之SO组和70%PH组,CBDL导致肝细胞能量代谢恶化、肝功能不良、肝组织HGF和bcl-2mRNA含量减少,肝再生受抑制,细胞凋亡显著增多(P<0.05)。胆肠内引流再通后肝细胞能量代谢可迅速恢复,肝细胞凋亡减少,肝再生活跃。42%+BDO-RBF组及70%PH+BDO-RBF组肝细胞能量代谢同样能够较快恢复,肝再生良好。42%+BDO-RBF组与70%PH+BDO-RBF组间各指标差异均无统计学意义(P>0.05)。结论梗阻性黄疸时,高胆红素血症严重影响肝细胞能量代谢和肝功能,引起肝细胞凋亡增多,肝再生受抑制;及时有效的胆肠内引流能够迅速改善肝细胞能量代谢、肝功能及肝再生,联合肝切除时术前可不需常规胆道引流。Objective To study the effectiveness of liver function,hepatic energy metabolism,regeneration,and apoptosis on the obstructive jaundice rat after partial hepatectomy（PH） combined with internal biliary drainage under the condition of conspicuous bilirubinemia. Methods One hundred and twenty male SD rats were used in research,six of whom were divided into sham operation（SO） group.Twenty rats underwent bridge operation between common bile duct and duodenum after 70% PH（70%PH group）,and 6 rats out of the 94 rats who underwent common bile duct ligation（CBDL） for 5 d were randomly selected as CBDL group,and the residual rats were done the second operations after 5 d and were divided into three groups： bile duct obstruction combined with reperfusion of bile flow group（BDO-RBF group,n=20）,42% PH with BDO-RBF group（n=20）,and 70%PH with BDO-RBF group（n=25）.Levels of TB,ALT,ALB,and ALP in serum;HGF,bcl-2 mRNA and protein;ATP,ADP,and AMP;hepatocyte proliferation/apoptosis index in hepatic tissues were dynamically observed after operation（24 h,72 h,and 7 d）,respectively.The liver function and hepatocyte energy metabolism were only detected in the SO group. Results Rats without obstructive jaundice would have an excellent liver regeneration after 70% PH,while the liver function and hepatocyte energy metabolism could recover rapidly.The liver function,hepatocyte energy metabolism,HGF and bcl-2 mRNA and protein of liver tissue and the hepatocyte proliferation/apoptosis index in partial（42% or 70%） hepatectomy combined with internal biliary drainage in obstructive jaundice group were significantly influenced while recovered rapidly（P〈0.05）. Conclusions Under the condition of conspicuous bilirubinemia,the influences of hepatectomy combined with internal biliary drainage on hepatocyte energy metabolism,liver function,hepatocyte regeneration and apoptosis are severer than that of normal rats who underwent 70% hepatectomy,while also make the rats recover rapidly in hyperbilirubinem

关 键 词：梗阻性黄疸 高胆红素血症 肝切除 胆道引流 

分 类 号：R657.43[医药卫生—外科学]