大鼠自体原位肝移植术后不同胆道热缺血时间对胆管及其周围血管丛的影响  

Effects of different biliary warm ischemia time on bile duct and peribiliary vascular plexus after autologous orthotopic liver transplantation in rats

作　　者：潘军平[1] 朱新华[1] 施晓雷[1] 吴亚夫[1] 丁义涛[1] 

机构地区：[1]南京大学医学院附属鼓楼医院肝胆外科,南京医学硕士210008

出　　处：《医学研究生学报》2013年第7期709-713,共5页Journal of Medical Postgraduates

摘　　要：目的胆管热缺血时间对供肝热缺血再灌注损伤后胆道及其微循环的影响正成为目前肝移植术后缺血型胆道病变的研究热点。文中探讨大鼠自体原位肝移植术后不同胆道热缺血时间对胆管及其周围血管丛的影响。方法将48只SD大鼠分为假手术组、延长胆道热缺血0 min实验组、延长胆道热缺血10 min实验组和延长胆道热缺血20 min实验组,建立了大鼠自体原位肝移植胆道外引流模型,于术后6 h和24 h留取血和肝样本检测血中血管内皮生长因子A(Vascular endothelialgrowth factor-A,VEGF-A)浓度,并进行免疫组化染色检测胆管及其血管丛增殖情况、胆管上皮细胞凋亡和常规病理检查。结果随着胆道热缺血时间的延长,实验组术后6h的VEGF-A浓度无明显差异,但3个实验组术后24 h的VEGF-A浓度显著降低。同时随着胆道二次热缺血时间的增加胆管上皮细胞凋亡指数相应增加,术后早期汇管区血管数和伴有血管的胆管数明显减少,胆管上皮细胞增殖指数显著降低,而不伴有血管的胆管数则明显增加。常规检查提示大鼠汇管区炎症增加,胆管上皮细胞损伤明显加重。结论大鼠原位肝移植术后随着胆道热缺血时间的延长会导致胆管及其周围血管丛的损伤加重,应该尽量减少肝移植术中二次胆道热缺血时间从而减轻胆管及其周围血管丛的损伤。Objective Effects of different biliary warm ischemia time on the bile duct and the peribiliary vascular plexus have been the most challenging problem for ischemic type biliary complications after orthotopic liver transplantation. The aim of this study is to explore the effects of different biliary warm ischemia time on the bile duct and the perihiliary vascular plexus after autologous orthotopic liver trans- plantation in rats. Methods Forty eight SD rats were randomly divided into sham-operation group and the other three operation groups with the secondary biliary warm ischemia time of 0 min, 10 min and 20 min. The model of autologous orthotopic liver transplantation in rats with ex- ternal biliary drainage was established, and blood and liver samples were harvested at 6 hours and 24 hours after transplantation. We detected the concentration of vascular endothelial growth factor-A （VEGF-A） in the blood, and conducted the immunohistochemJcal staining to detect the proliferation of the bile duct and the peribiliary vascular plexus. The apoptosis test of bile duct epithelial cell and conventional pathologi- cal examination were also conducted in this study. Results With the extension of the biliary warm ischemia time, VEGF-A levels were sig- nificantly decreased at 24 h in the three operation groups with no significant differences at 6 h. With the increase of the biliary tract secondary warm ischemia time, a corresponding significant increase of bile duct epithelial cell apoptosis was shown. The number of bile duct, blood vessels, bile duct surrounding with blood vessels and bile duct epithelial cell proliferation index in the early postoperative portal area de- creased with the extended secondary biliary ischemia time, and the number of bile duct which was not surrounded by blood vessels increased significantly. The pathologic examinations of the rats showed that the inflammation of the rat portal area increased, and the injury of biliary epithelial cell was significantly worse. Conclusion The extension of bil

关 键 词：肝移植 自体 热缺血 大鼠 胆道 

分 类 号：R657.3[医药卫生—外科学]