门肝分流术治疗猪肝硬化门脉高压症  

Treatment with portal vein-hepatic artery shunt for liver cirrhosis and portal hypertension in pigs

作　　者：廖清华[1] 田磊[1] 林伟箭[1] 吴向华[1] 黄理哲[1] 张海添[1] 

机构地区：[1]广西医科大学第一附属医院胃肠腺体外科,530021

出　　处：《中华肝胆外科杂志》2013年第9期706-710,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：广西壮族自治区科技厅资助项目（0719006-2-26）

摘　　要：目的观察肝侧门静脉一肝总动脉侧端分流术和侧侧分流术（统称门肝分流术）对猪肝硬化门脉高压症动物模型的治疗效果。方法对照组和实验组（即肝硬化门脉高压模型组）实验猪各15头分别行门肝分流术，观察门静脉血入肝及降压的过程。结果对照组和实验组门肝分流术前门静脉压力分别为（20．51±0．74）cmH2O（1 cm H2O=0．098kPa）和（30．82±2．53）cmH2O（P〈0．05）；术后30d分别为（19．75±0．84）cmH2O和（20．84±1．36）cmH2O（P〉0．05）。对照组和实验组门静脉与肝总动脉的压力差术前分别为（7．20±0．34）cmH2O和（17．34±0．62）cmH2O（P〈0．05）；术后30d分别为（6．40±0．21）cmH2O和（7．84±1．32）cmH2O（P〉0．05）。分流后术中脾静脉注射亚甲蓝肝脏染色良好。术后观察30d无肝坏死及肝性脑病发生，脾肿大恢复正常。门肝分流术对肝功能的影响较大，对其他血生化代谢指标影响较小。结论门肝分流术后虽然门静脉血入肝通道发生变更，但门脉血流动力学并未受到显著影响，反而建立了新的平衡机制来维持门脉血流动力学的稳定，达到门脉降压效果。门肝分流术后肝功能恢复所需时间较长，且需进一步治疗。Objective To observe the therapeutic effects of end-to-side and side-to-side portal vein-hepatic artery shunts （P-H shunt） in pigs with liver cirrhosis and portal hypertension. Methods There were 15 pigs in each group （control and experimental）, and the P-H shunt was made in each an- imal to observe the process of blood flow into the liver and the reduction of portal vein blood pressure. Results The portal vein pressures before the P H shunt of pigs in the control and experimental group were （20.51±0.74） cm H2O （1 cm H2O=0. 098 kPa） and （30.82±2.53） cm H2O respectively （P〈0.05）. Portal vein pressures 30 days after the PH shunt were（19.75±0.84） cm H2O and （20.84± 1.36） cm H2 O respectively （P〉0.05）. The portal vein pressure differences of pigs in the control and experimental group before P-H shunt were （7.20±0.34） cm H2O and （17.34±0.62） cm H2O respectively （P〈0. 05）. Pressures differences 30 days after the P-H shunt were （6.40±0.21） cm H2O and （7.84±1.32） cm H2O respectively （P〈0.05）. Splenic vein injection of methylene blue after the P-H shunt operation stained the liver well. No necrosis and hepatic encephalopathy occurred for 30 days after the P-H shunt, and the splenomegaly gradually returned to normal. Liver function was most affected after the operation and other biochemical markers were least affected. Conclusions The P-H shunt changed the channel of blood flow into the liver, the portal hemodynamic was not affected, and a new balanced mechanism was established to maintain the portal hemodynamic stability. However, further treatment was needed for liver function recovery.

关 键 词：肝硬化 门脉高压症 动物模型 门肝分流术 

分 类 号：R575.2[医药卫生—消化系统]