不同断流术式对门静脉高压症犬胃黏膜细胞凋亡的影响

Effect of different portal-azygos devascularization procedures on apoptosis of gastric mucosal cells in portal hypertension canines with cirrhosis

目的检测对不同断流术式前后门静脉高压症犬胃黏膜细胞凋亡，观察其对门脉高压性胃病（PHG）影响。方法将肝硬化门静脉高压症模型犬24条，随机分为A组（传统断流组）、B组（选择性断流组）、C组（吻合器断流组）及D组（对照组），每组6条。分别于术中及术后6个月测自由门静脉压（FPP），取胃组织，采用原位末端脱氧核苷标记法（TUNEL）染色测凋亡指数（AI）及Caspase-3蛋白免疫组织化学染色计算各染色强度细胞评分总和（H值）。结果术后6个月内，A、B、C组FPP均明显下降，其中以B组下降最为明显，其次为C组，最后为A组。术后6个月，A组AI值由术前的（14．68±1．28）％增至（20．22±2．20）％（P〈0．05），H值由术前的56．13±11．75增至113．78±19．80（P〈0．05）；B组AI值由术前的（13．63±1．19）％降至（9．98±2．29）％（P〈0．05），H值由术前的59．134±10．07降至22．354±4．75（P〈0．05）。C、D组术后6个月与术前比较，AI和H值无明显变化（P〉0．05）。结论肝硬化门静脉高压症犬行传统断流术术后胃黏膜细胞凋亡加重，PHG病变程度加剧；选择性断流术后胃黏膜细胞凋亡减轻，PHG病变程度改善；吻合器断流术后胃黏膜细胞凋亡变化无差异，对PHG病变影响不大。

Objective To detect apoptosis of gastric mucosal cells in portal hypertension canines with cirrhosis after different portal-azygos devascularization procedures and investigate their effects on portal hypertension gastropathy （PHG）. Methods Portal hypertension was induced in canines by subcutaneous injection of 60% CCl4 emulsion and diet control. Twenty-four portal hypertension model canines were randomly divided 4 groups：group A （traditional paraesophagogastric devascularization group）, group B （selective paraesophagogastric devascularization group）, group C （selective paraesophagogastric devascu larization plus distal esophageal transaction and reanastomosis with stapler group）, and group D （control group, sham operation）. The changes in free portal pressure （FPP） and apoptosis of gastric mucosa cells were observed during operation and 6 months after operation. Apoptosis index （AI） was measured by TUNEL,and the expression of Caspase-3 was detected by immunohistotchemistry. Results FPP in groups A,B and C were decreased significantly post-operation and at the 6th month post-operation as compared with pre-operation （ P 〈 0.05 ）. FPP in group A （2.05 ±0. 07 ） kPa was significantly higher than that in groups B （1.28±0.05） kPa and C （1.41±0.04） kPa （P〈0.05） ,and that in group C higher than in group B （P 〈 0.05 ）. At the 6th month post-operation, AI was increased significantly from （ 14.68 ± 1.28） % to （ 20.22± 2.20 ） % （ P 〈 0.05 ）, and the expression of Caspase-3 was also increased from 56.13 ± 11.75 to 113.78 ±19.80 （P 〈 0.05）. In group B, AI was decreased from （ 13.63± 1.19 ） % to （9.98 ±2.29）% （P 〈0.05） ,and in group A the expression of Caspase-3 was decreased from 59.13 ± 10.07 to 22.35 ±4.75 （P 〈0.05）. In groups C and D,AI and the expression of Caspase-3 had no significant difference before and 6 six months post-operation （ P 〉 0.05 ）. Conclusion In portal hypertension canines with cirrhosis,the apoptosis of gastric mucosa cells is increased, and PHG aggravates after traditional paraesophagogastric devascularization. Selective paraesophagogastric devascularization can ameliorate the apoptosis of gastric mucosa cells and PHG. The apoptosis of gastric mucosa cells and PHG have no significant changes after selective paraesophagogastric devascularization plus distal esophageal transaction and reanastomosis with stapler.