选择性肾段动脉钳夹阻断对孤肾猪肝脏的影响  

Effect of selective segmental renal artery damping on the liver

作　　者：储铸钢 徐述雄[1] 彭都 徐元高[1] 赵朝祥 赵海[2] 王转[3] 王元林[1] 

机构地区：[1]贵州医科大学附属人民医院泌尿外科,贵阳550002 [2]贵阳中医学院实验动物研究所,550002 [3]贵州医科大学公共卫生学院,贵阳550025

出　　处：《中华实验外科杂志》2016年第6期1477-1479,共3页Chinese Journal of Experimental Surgery

基　　金：基金项目：贵州省科技厅一贵州省人民医院联合基金（黔科合LSE20123005）;贵阳市社会发展与民生科技计划基金（筑科合同[2012103]056号）;贵州省卫生计生委基金（gzwjkj-2015-1-024）

摘　　要：目的观察选择性肾段动脉钳夹阻断（SSRAC）对孤肾猪肝脏的影响。方法18头猪随机分成两组，即肾动脉主干钳夹阻断（MRAC）组和SSRAC组，每组9头。先切除右肾，MRAC组钳夹左肾动脉主干，SSRAC组钳夹左肾动脉下极支，两组均钳夹60min后去除血管夹。术前当天及术后第1、7、、1421、28、90天抽血，全自动生化仪检测谷丙转氨酶（ALT）和谷草转氨酶（AST）；术后第1天和第90天，取肝脏行病理观察。结果术后第1天，MRAC组ALT和AST分别为（79．00±9．30）U／L和（264．00±59．85）U／L，明显高于SSRAC组[（52．80±5．81）U／L和（143．20±29．22）U／L，P〈0．05]；术后第7、14、21、28、90天两组ALT和AST水平均在正常范围内，差异无统计学意义（P〉0．05）。MRAC组在术后第1天，肝脏见广泛的肝细胞水样变性并部分肝细胞气球样变，多灶性点状坏死；术后第90天，上述病理改变明显减轻。而SSRAC组在对应的时间点，肝脏病理改变均较MRAC组轻。结论与MRAC比较，SSRAC对肝脏有一定的保护作用，提示在肾部分切除术（PN）中要尽可能选用SSRAC。Objective To evaluate the effect of selective segmental renal artery clamping （SSRAC） on the liver so as to provide a foundation for the using of SSRAC in partial nephrectomy （PN）. Methods A total of 18 domestic pigs were randomized equally into 2 groups according to the method of re- nal artery clamping such as main renal artery damping （MRAC） and SSRAC. Each subject underwent rad- ical nephrectomy to right kidney, and then either MRAC or SSRAC was performed to left kidney for 60 mi- nutes. Alanine aminotransferase （ALT） and aspartate aminotransferase （AST） were measured before sur- gery and at 6 time points thereafter （day 1,7, 14, 21,28, 90）. Liver histology was observed on the first day and the 90th day after operation. Results On the first day after operation, ALT and AST values of the MRAC group were （79. 00 ±9. 30） U/L and （264.00 ±59. 85） U/L, which was significantly higher than those of SSRAC group [ （52. 80 ± 5.81 ） U/L and （ 143.20 ± 29. 22） U/L, P 〈 0.05 ]. On the 7th, 14th, 21st, 28th and 90th day after operation, serum ALT and AST values of the two group were normal and there were no differences between the two groups （ P 〉 0. 05 ）. In the MRAC group the liver experienced exten- sive hydropic degeneration, partial hepatic cells vacuolization and muhifocal necrosis on the 1 st day, and the above pathological changes were significantly attenuated on the 90th day. However, the liver pathologi- cal injury in SSRAC group was less at the two time points. Conclusion Compared with MRAC, SSRAC has a protective effect on liver postoperatively. It＇ s better to choose SSRAC during PN.

关 键 词：选择性肾段动脉钳夹阻断 肾动脉主干钳夹阻断 肾部分切除 肾缺血再灌注损伤 肝损伤 

分 类 号：R692[医药卫生—泌尿科学]