保留肝动脉入肝血流阻断法对肝硬化大鼠肝脏的保护作用  

Protective effect of portal vein occlusion without hepatic artery inflow control on cirrhotic rat liver

作　　者：胡建军[1] 李崇辉[1] 王洪东[1] 纪旭[1] 葛新兰[1] 潘可[1] 董家鸿[1] 

机构地区：[1]解放军总医院肝胆外科全军肝胆外科研究所,北京100853

出　　处：《中华肝胆外科杂志》2013年第1期62-65,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：国家科技支撑计划（2012BA106B01）;国家自然科学基金项目（81271738）

摘　　要：目的 探讨保留肝动脉入肝血流阻断法对硬化肝脏缺血再灌注损伤的预防保护作用.方法 四氯化碳大鼠肝硬化模型及正常大鼠根据血流阻断方式分为4组：正常对照（N-SO）组；硬化对照（C-SO）组；Pringle阻断（PTC）组；保留肝动脉血供入肝血流阻断（PVC）组.于阻断期比较各组肝切除术中肝断面出血量.复流后1h、6h及24 h取标本,检测血清丙氨酸转氨酶（ALT）、肝组织三磷酸腺苷（ATP）及丙二醛（MDA）含量,制作组织病理切片行形态学观察.结果 肝断面出血量PTC组＜PVC组＜N-SO组＜C-SO组（P＜0.05）.复流1h、6h及24 h,血清ALT值及肝组织MDA值检测PTC组＞PVC组＞C-SO组＞N-SO组（P＜0.05）；肝组织ATP值PTC组＜PVC组＜C-SO组＜N-SO组（P＜0.05）；肝脏形态学观察,PTC组及PVC组病理改变重于C-SO组,PTC组损伤程度更重.结论 保留肝动脉血供入肝血流阻断法可有效控制肝硬化大鼠肝断面出血,并显著减轻肝脏缺血再灌注损伤.Objective In order to improve cirrhotic liver management,each aspect of the liver＇s complex blood flow must be understood.This study investigates the protective effect of portal vein occlusion,with hepatic artery preservation,on cirrhotic liver after ischemia and reperfusion.Methods Carbon tetrachlorideand induced cirrhotic rats and normal rats were randomly assigned into 4 groups：normal sham operation （N-SO）,cirrotic sham operation （C-SO）,portal triad clamping （PTC）,and portal vein clamping without hepatic artery inflow control （PVC）.During the occlusion,the total 3-minute blood loss from the liver surface cut was weighed.At 1,6,and 24 hours post reperfusion,the serum alapine amino transferas （ALT）,the adenosine triphosphate （ATP） of liver tissue,the malonolialdehgde （MDA） of liver tissue,and the morphological changes were evaluated.Result The amount of hemorrhage between the groups ranked as follows：PTC 〈 PVC 〈 N-SO 〈 C-SO （P〈0.05）.At 1,6,and 24 hours post reperfusion.the ALT and MDA levels of the groups ranked as follows：PTC 〉 PVC 〉 C-SO 〉 N-SO （P〈0.05）.Additionally,each group＇s ATP level ranked as follows：PTC 〈 PVC 〈 C-SO 〈 N-SO （P〈0.05）.With histopathological examination,the hepatic injuries of the PTC and PVC group were more severe than those of the C-SO group,especially in the PTC group.Conclusion Therefore,the technique of portal vein clamping and hepatic artery inflow control can reduce the ischemic reperfusion injury of the cirrhotic rats＇ liver.

关 键 词：肝脏 血流阻断 再灌注损伤 肝硬化 大鼠 

分 类 号：R657.31[医药卫生—外科学]