逆灌注条件下不同复流顺序对肝移植患者术后早期肝功能及肝细胞超微结构的影响  

The influence of different sequences of revascularization on ultrastructural changes in the graft liver and the recovery of short-term liver function after liver transplantation with retrograde reperfusion

作　　者：杨芳 王华翔 许蜂蜂 江艺 Yang Fang;Wang Huaxiang;Xu Fengfeng;Jiang Yi(Department of Hepatobiliary Surgery,900 Hospitalof the Joint Logistics Team,Fuzhou 350025,China)

机构地区：[1]联勤保障部队第900医院肝胆外科,福州350025 [2]厦门大学附属东方医院肝胆外科

出　　处：《中华肝胆外科杂志》2018年第12期797-801,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：福建省自然科学基金(2015Y0026).

摘　　要：目的探讨逆灌注条件下门静脉、肝动脉不同复流顺序对肝移植患者缺血/再灌注损伤和术后早期肝功能恢复的影响。方法回顾性分析联勤保障部队第900医院2009年1月至2013年6月97例经典原位肝移植患者资料。依据不同复流顺序分为:R—IPR组(门静脉先复流,35例),R—IAR组(肝动脉先复流,30例),R—SAPR组(门静脉肝动脉同时复流,32例)。术前1天,术后1、3、5、7天监测肝功能、凝血功能等相关指标,用透射电镜观察复流后2h肝内胆管上皮细胞及肝细胞超微结构,图像分析系统计量分析线粒体形态。结果R—IPR组、R—SAPR组及R—IAR组胆管二次热缺血时间(WITⅡ)呈依次下降趋势,差异有统计学意义(P<0.05)。术后1d,R—IAR组丙氨酸氨基转移酶[(471.3±86.7)U/L比(562.2±150.4)U/L比(553.2±153.1)U/L]、吖谷氨酰转肽酶[81.3±25.9)U/L比(115.8±39.3)U/L比(110.8±42.7)U/L]和总胆红素[(91.4±42.6)μmol/L比(124.9±49.4)μmol/L比(129.0±45.8)μmol/L]均低于R—IPR组与R—SAPR组,差异有统计学意义(P<0.05)。且R-IAR组、R—SAPR组、R—IPR组胆管细胞线粒体肿胀程度依次加重,R—IAR组线粒体平均面积、周长较其他两组减小,差异有统计学意义(P<0.05)。结论经典原位肝移植在逆灌注条件下,先开放肝动脉可促进肝移植术后早期肝脏功能恢复,并且由于胆道WITⅡ缩短,还减轻了胆道系统的缺血/再灌注损伤。Objective To study the influence of sequential and contemporaneous revascularizations of portal vein and hepatic artery during liver transplantation with retrograde reperfusion on the ultra-structural changes in intrahepatie cholangiocytes of the graft with liver ischernia reperfusion injury,and the recovery of short-term liver function after operation.Methods The clinical data of 97patients who underwent orthotopie liver transplantation (OLT)using retrograde reperfusion via the vena eava (IVC)in our hospital from January,2009to June,2013were retrospectively analyzed.Using to the different sequences of revascularization, 97eligible patients were divided into three groups:group R-IPR:the initial arterial revascularization group (35patients);group R-IAR:the initial portal revascularization group (30patients);group R-SAPR: simultaneous reperfusion group (32patients).Liver function,coagulation function and other related parameters were continuously monitored for the transplant recipients at the following time points :1day before operation,2hours after reperfusion and on postoperative Day 1,2,5 and 7.The ultra-structure of intrahepatic bile duct epithelial cells at 2hours after reperfusion were studied by transmission electron microscopy and morphometrie analysis of mitochondria was performed by the computer image analysis system.Results The levels of ALT,GGT and TB in group R-IAR were significantly lower than those in group R-IPR and group R-SAPR (P<0.05).There were no significant differences among the three groups in other parameters that reflected liver function at any time point (P>0.05).In group R-IAR and group R-IPR,mitochondrial swell- ing of bile duct epithelial cells was more severe than that in group R-SAPR.There were significant differences among the three groups in the mitochondrial average area and the average perimeter (P<0.05). Mild swellin^of mitoehondria in hepatic cells was observed in ffrouo R-IAR and grouo R-IPR.There was no significant difference in the mitochondrial average area and average perim

关 键 词：原位肝移植 逆灌注法 复流顺序 缺血/再灌注损伤 肝功能 细胞超微结构 

分 类 号：R657.3[医药卫生—外科学]