脾血管结扎术与脾切除术影响脾功能的动物实验研究  

Effects of splenic vascular ligation and splenectomy on splenic functions

作　　者：张金山[1] 李龙[1] Zhang Jinshan;Li Long(Department of General Surgery,Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所普外科,北京100020

出　　处：《中华小儿外科杂志》2023年第6期508-513,共6页Chinese Journal of Pediatric Surgery

基　　金：国家自然科学基金(82170679)。

摘　　要：目的明确脾血管结扎术与脾切除术对脾脏功能的影响。方法将32只6~8周龄雄性SD大鼠按随机数字表法平均分为4组:正常组、对照组、脾血管结扎组和脾切除组。正常组不做任何操作;对照组仅进行开腹操作;脾血管结扎组采用结扎大部分脾动静脉血管的方法进行模型制作;脾切除组采用脾切除的方法进行模型制作。记录手术时间、失血量、胃肠道功能恢复时间(首次进食时间)。收集正常组和术后1个月时对照组、脾血管结扎组和脾切除组的血液样本,用于脾功能的检测(机体免疫功能、脾清除功能和抗感染能力)。采用流式细胞术检测细胞免疫水平(CD3+T淋巴细胞、CD4+T淋巴细胞、CD8+T淋巴细胞所占比例,并统计CD4+T/CD8+T细胞计数比值)和酶联免疫吸附试验检测体液免疫水平[血清免疫球蛋白(immunoglobulin,Ig)G、IgA和IgM水平、外周血白细胞介素(interleukin,IL)-1β、IL-2、IL-6、转化生长因子-β1(transforming growth factor-β1,TGF-β1)和肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平]评价机体免疫功能。采用示差显微镜计数痘痕红细胞出现率评价脾的清除功能。采用内毒素试剂盒检测内毒素水平评价脾的抗感染能力。采用血常规检测红细胞、白细胞、血小板和血红蛋白计数。两组间比较采用t检验,不同组间两两比较采用One-way ANOVA检验。结果正常组和对照组间脾功能(机体免疫功能、脾清除功能和抗感染能力)差异无统计学意义(均P>0.05)。脾切除组比脾血管结扎组的手术时间[(37.5±6.0)min比(22.5±6.0)min,P<0.001]、手术失血量[(1.7±0.5)ml比(0.9±0.5)ml,P=0.011]、胃肠道功能恢复时间[(6.6±0.9)d比(5.1±1.0)d,P=0.007]显著增加。与正常组和对照组相比,脾血管结扎组和脾切除组中IgG、IgA和IgM水平、CD3+T淋巴细胞、CD4+T淋巴细胞和CD8+T淋巴细胞比例显著降低(均P<0.001);外周血IL-1β、IL-2、IL-6、TNF-α和TGF-β1Objective To evaluate splenic functions after splenic vascular ligation and splenectomy.Methods Thirty-two Sprague-Dawley(SD)rats were randomized into four groups of normal,control,splenic ligation and splenectomy.No operation was performed in normal group,laparotomy alone was performed in control group and most splenic vessels were ligated in splenic ligation group.Operative duration,blood loss and recovery time of gastrointestinal function(initial ingesting time of post-operation)were recorded.Blood samples of four groups were collected at Month 1 post-operatively for detecting the splenic functions of immunity,clearance and anti-infection.The levels of cellular immunity including the proportions of CD3+T,CD4+T and CD8+T lymphocytes and the ratio of CD4+T to CD8+T lymphocytes were detected by flow cytometry;the levels of humoral immunity including the serum levels of IgG,IgA and IgM and peripheral blood interleukin-1β(IL-1β),interleukin-2(IL-2),interleukin-6(IL-6),transforming growth factor-β1(TGF-β1)and tumor necrosis factor-α(TNF-α)were detected by enzyme-linked immunosorbent assay(ELISA).The incidence of pockmarked erythrocytes was counted by differential microscope for evaluating the clearance function of spleen.The activity of endotoxin was detected by endotoxin kit for evaluating the anti-infection capability of spleen.The levels of red blood cell(RBC),white blood cell(WBC),platelets(PLT)and hemoglobin(HGB)were measured.Results Operative duration[(37.5±6.0)vs(22.5±6.0)min,P<0.001],blood loss[(1.7±0.5)vs(0.9±0.5)ml,P=0.011]and recovery time of gastrointestinal function[(6.6±0.9)vs(5.1±1.0)day,P=0.007]were significantly higher in splenectomy group than those in splenic ligation group.No significant inter-group difference existed in splenic function.Comparing normal and control groups,the levels of IgG,IgA and IgM and the proportions of CD3+T,CD4+T and CD8+T lymphocytes dropped markedly(all P<0.001);the levels of IL-1β,IL-2,IL-6,TNF-α,TGF-β1,endotoxin,RBC,WBC,PLT and HGB and the incidence of p

关 键 词：脾切除术 脾 脾功能亢进 

分 类 号：R-332[医药卫生]