深低温对肝脏Glisson管道三级分支以上区域的冷冻效应

Cryo-effect of profound hypothermia for the upper area of tertiary branches of hepatic Glisson's duct

目的了解深低温对肝脏Glisson管道三级分支以上区域的冷冻效应。方法30只小猪,随机分为4组,用平底冷冻头分别对A组动物第一肝门部、B组动物左肝外叶的Glisson管道、C组动物左肝外叶Glisson管道的主要分支区域进行3分钟的直接深低温冷冻(冷冻时阻断肝门);对照组:仅阻断肝门3分钟。术后观察动物血清肝功能的改变,患肝的病理变化,并用彩超了解受冻管道的情况。结果A组动物肝门部的胆管系统在冷冻后出现严重损伤,表现为进行性、不可逆的胆管坏死、狭窄、胆瘘、化脓性胆管炎等并发症,肝门部较大坏死物质也会对门静脉造成压迫;在B、C组,冷冻可造成受冻部位肝实质、胆管及门静脉分支管壁的坏死,而肝动脉分支不受影响,术后8周原冷冻区的肝动脉、门静脉分支的管腔依然保持通敞,所在肝叶萎缩、纤维化。结论如对第一肝门部进行直接深低温冷冻,应注意避免损伤胆管系统;而机体可耐受对部分肝叶Glisson氏管道系统二、三级分支区域的直接深低温冷冻,冷冻可造成受冻部位肝实质的坏死,达到外科治疗目的。

Objective To understand the area of tertiary branches of hepatic Glisson＇s duct. cryo-effect of profound hypothermia for the above Methods 30 pigs were randomly divided into 4 Serology, Colour Doppler ultrasonography and pathological change were studied to evaluate these procedures postoperatively. Results In the group A, the biliary tract system on first porta hepatis was severely destroyed after cryosurgery. It＇s manifestions of complication were progressive, irreversible biliary necrosis, stenosis, fistula and pyogenic cholangitis. Protal vein was compressed by more freezing necrotic tissue. In the group B and C, cryo-therapy could induce necrosis of hepatic parenchyma and the wall of biliary tract and protal vein branches. However, the branches of hepatic artery was not be influenced. The lumens of hepatic artery and portal vein branches of frozen area were kept fluently, but atrophy and fibrosis of local hepatic lobe were occured in the 8 weeks after operation. Conclusion If direct profound hypothermia was performed in the first porta hepatis, it should pay attention to avoid the injury of the biliary system. The organisms （animals） can tolerate the treatment of the direcf profound hypothermia for secondary and tertiary branches area of Glisson＇s biliary system of partial hepatic lobe. Refrigeration can make local parenchymal necrosis of liver. At the same time, it can reach to the purpose of surgieal treatment.