常温下长时间阻断肝血供的实验与临床研究

Experimentive and Clinical Study . of Long Time Occlusion of Hepatic Blood Flow Under Normothermia

为了观察常温下阻断入肝血供不同时期肝脏的变化，探讨肝脏的温缺血时限。方法：常温下阻断Ｗｉｓｔａｒ大鼠入肝血供３０分钟（Ａ组）、４５分钟（Ｂ组）及６０分钟（Ｃ组），观察肝细胞的形态、结构、肝血窦内皮细胞的超微结构，酶学指标ＡＩｌＴ、ＡＳＴ的改变。结果：常温下鼠肝血流阻断在的分钟内肝脏的改变为可逆性改变。肝脏酶学Ａ、Ｂ和Ｃ组ＡＬＴ、ＡＳＴ明显高于正常（Ｐ＜０．００１），Ａ组与Ｂ组之间无显著性差异（Ｐ＞０．０５），Ｃ组ＡＬＴ、ＡＳＴ高于ＡＤ组（Ｐ＜０．０１）。应用此方法成功地为１５例患儿行肝叶切除术，认为该方法应用于小儿简单、安全。

To study the limited normothermic ischemia of the liver , the hepatic blood flow of 3 groups of Wistar rats (each consisting of 10 rats ) was occluded for 30 , 45 and 60 min. respectively. The ch8nges of hepatocytic morphology . ultrastructure of sinusoidal endothelial cells and microcirculation of liver . and serum values of ALT . and AST were observed. The results showed that while the time of normothermic ischemia was less than 45 min , the changes of hepatocytes and. microcirculation were reversible. The values of ALT and AST were significantly lower than that of the ischemia time of. 60 min group (P<0. 01 ) . Using this method . l5 cases with liver neoplasms were suecessfully performed on hepatectomy. It is concluded .that occlusion of hepatic blood 8ow for 45 min is safe . This method is simple and helpful to hepatectomy in children.