不同引流方式对梗阻性黄疸大鼠部分肝切除术后肝再生的影响  

Effects of different biliary drainage methods on liver regeneration of obstructive jaundice rats after partial hepatectomy

作　　者：袁晟光[1] 梁科伟[1] 刘杰[1] 廖维甲[1] 覃理灵[1] 何松青[1] 

机构地区：[1]桂林医学院附属医院肝胆外科,541001

出　　处：《中华消化外科杂志》2013年第12期956-962,共7页Chinese Journal of Digestive Surgery

基　　金：广西卫生厅医疗卫生重点科研项目（重200983）

摘　　要：目的探讨不同引流方式对梗阻性黄疸大鼠部分肝切除术后肝再生的影响。方法建立梗阻性黄疸70％部分肝切除sD大鼠模型。随后将120只sD大鼠按照随机数字表法分为对照组：行肝中、左叶切除；内引流组：于扩张胆管和十二指肠间置管引流；外引流组：于扩张胆管置管，导管另-端从腹腔引出。每组40只大鼠。内引流组和外引流组引流7d后行肝中、左叶切除，于术后0、1、2、4、12、24、48、72h收集3组大鼠血液及肝脏组织标本，测定肝再生率、有丝分裂指数。采用免疫组织化学染色法观察肝脏组织增殖细胞核抗原（PCNA）及信号传导与转录激活因子3（STAT3）的表达，ELISA法检测血清TNF．OL、IL-6水平，RT．PCR测定肝脏组织TNF—OLmRNA和IL-6mRNA的表达。组间比较采用单因素方差分析，两两比较采用SNK检验。结果部分肝切除术后72h内引流组sD大鼠肝再生率为94．86％±12．72％，显著高于外引流组的62．39％±8．01％和对照组的45．77％±5．41％（F=33．62，P〈0．05）。3组大鼠肝脏组织有丝分裂指数和PCNA水平均于12h明显升高，内引流组有丝分裂指数和PCNA水平均于24h达到高峰，分别为24．47％±4．01％和88．1％±9．2％，对照组和外引流组于48h达到高峰，分别为15．80％±1．08％和58．3％±5．8％、18．40％±1．12％和70．2％±6．9％。内引流组有丝分裂指数和PCNA水平峰值显著高于对照组和外引流组（P〈0．05）。内引流组STAT3表达于术后4h达到高峰，为42．6％±3．6％，对照组和外引流组分别于术后12h达到高峰，分别为22．9％±2．0％和29．2％±3．7％。内引流组STAT3表达峰值显著高于对照组和外引流组（P〈0．05）。内引流组TNF—d和IL-6水平均于术后12h达到高峰，分别为（227±23）U／L和（256±32）U／L；对照组和外引流组TNF—d和IL-6水平均于术后24h达到高峰，分别为（309±41Objective To investigate the effects of internal and external biliary drainage on liver regeneration of the obstructive jaundice rats after partial hepatectomy. Methods The rat models of obstructive jaundice with 70% liver resection were successfully constructed. All the 120 rats were randomly divided into the control group： rats received middle and left hepatic lobectomy; internal drainage group： a drainage tube was placed between the dilated bile duct and the duodenum; external drainage group： a drainage tube was placed in the dilated bile duct. There were 40 rats in each group. Rats in the internal and external drainage groups received middle and left hepatic lobectomy at postoperative day 7. The blood and hepatic tissues were collected at postoperative day 0, 1,2, 4, 12, 24, 48, 72 hours after operation, and the rate of liver regeneration and mitotic index were determined. The expression of proliferating cell nuclear antigen （PCNA） and signal transducer and activator of transcription 3 （STAT3） in the hepatic tissues were detected by immunohistochemistry, and the levels of tumor necrosis factor-c~ （TNF-c~） and interleukin-6 （IL-6） were detected by ELISA, and the mRNA expressions of TNF-c~ and IL-6 were detected by RT-PCR. All data were analyzed using the one way analysis of variance or SNK test. Results Within 72 hours after partial hepatectomy, the rate of liver regeneration of the internal drainage group was 94.86% ＋- 12.72% , which was significant higher than 62.39% ＋-8.01% of the external drainage group and 45.77% ＋ 5.41% of the control group （F = 33.62, P 〈 0.05）. The mitotoic index and PCNA levels of the 3 groups had obvious increase at postoperative hour 12, and the mitotoic index and PCNA levels of the external drainage group reached peak at postoperative hour 24, which were 24.47% ＋- 4.01% and 88.1% ＋ 9.2% , respectively, the mitotoic index and PCNA levels of the control group and the external drainage group reached peak at postoperative hour 48, which were 15.80%

关 键 词：梗阻性黄疸 肝再生 胆道引流 IL-6 信号转导与转录激活因子3 

分 类 号：R657.3[医药卫生—外科学]