门静脉动脉化对梗阻性黄疸时肝胆切除术后肝再生的影响

Effect of portal vein arterialization on liver regeneration after hepato-bUiary resection in miniature pigs with obstructive Jaundice

目的观察慢性、梗阻性黄疸小型猪肝-胆切除术中限流性部分门静脉动脉化（PPVA）对术后残肝再生能力的影响。方法利用梗阻性黄疸小型猪模型，模拟进行联合半肝切除的肝门部胆管癌扩大根治性手术。实验分组：无黄疸对照组（A组）、门静脉动脉化组（B组）及非门静脉动脉化组（C组）。对照观察根治术中应用限流性PPVA在术后30d内对残肝再生的作用。结果术后即刻及第30天门静脉PO2：B组高于C组[（47．33±2．43）比（35．38±4．06）mmHg（1mmHg=0．133kPa）、（48．50±4．44）比（35．55±2．55）mmHg，P〈0．01、P〈0．01]。肝细胞有丝分裂指数：术后第14及21天B组高于C组[（12．55±2．85）％比（6．85±2．10）％、（15．25±1．99）％比（11．88±1．15）％，P〈0．05、P〈0．05]。术后第14、21天肝脏体积再生率B组分别高于C组[（24，56±6．15）％比（11．96±5．43）％、（70．63±9．83）比（44．92±7．42）％，P〈0．05、P〈0．01]。结论限流性PPVA可促进慢性梗黄小型猪肝-胆切除术后残肝再生，从而预防肝功能衰竭。

Objective To investigate the effect of flow-controlled partial portal vein arterializationg （PPVA） remnant liver regeneration following hepato-biliary resection （EHBR） in miniature pigs with chronic obstructive jaundice. Methods Eight miniature-pig models with chronic obstructive jaundice were divided into 2 groups with 4 pigs each ： PPVA group （group B）, non-PPVA group （group C ）, and another 4 pigs without chronic obstructive jaundice seveved control group （ group A）. Approaches of EHBR with or without PPVA were done. The effects of flow-controlled PPVA on remnant liver regeneration and prevention of liver failure were studied on the postoperative day 30. Results （ 1 ） Portal vein PO2 in group B was significantly higher than in group C on the postoperative day 0 and 30 respectively [ （47.33 ± 2.43） vs （35.38±4.06） mmHg（lmmHg=0.133kPa）,（48.50±4.44 ） vs （35.55±2.55） mm Hg, P 〈 0.01, P 〈 0.01 ] ; （2） Mitotic index （ MI ） of hepatocyte in group B was significantly higher than in group C on the postoperative day 14 and 21 respectively [ （ 12.55 ± 2.85 ） % vs （ 6.85 ± 2.10 ） %, （15.25 ±1.99）% vs （11.88 ± 1.15）% ,P 〈0.05,P 〈0.05] ;（3） Liver volume regeneration ratio in group B was significantly higher than in group C on the postoperative day 14 and 21 respectively [ （24.56 ±6.15）% vs （11.96 ±5.43）%, （70.63 ±9.83）% vs （44.92 ± 7.42）% ,P 〈0.05,P 〈 0.01 ]. Conclusion How-controlled PPVA is beneficial to the remnant liver regeneration and prevention of liver failure in EHBR on miniature pigs with chronic obstructive Jaundice.