不同门奇断流术式对门静脉高压症犬食管下段血管再生的影响

Effect of different procedures of paraesophagastric devascularization on blood vessel regenerationof distal esophagus in canines of portal hypertension with liver cirrhosis

目的观察不同断流术式对肝硬化门静脉高压症犬术后食管下段血管再生的影响。方法将肝硬化门静脉高压症模型犬48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12条，术后随机分为A1、B1、C1、D1和A2、B2、C2、D2组，分别于术后1、6个月处死取食管下段分段切片，其中C组取材时注意分清吻合口的上、下方，分别记为Ca、Cb。用免疫组织化学方法检测所取组织中血管特异性因子血管内皮生长因子（VEGF）、CD34及Ⅷ因子相关抗原（FⅧ-Rag）的表达。结果术后1个月A1、B1、C1组食管下段各层VEGF的表达及CD34 MVD、FⅧ-Rag MVD明显低于D1组（P〈0．05），B1组各指标明显低于A1组及Clb组，但明显高于C1a组（P均〈0．05），C1a组各指标明显低于C1b组（P〈0．05）。术后6个月A2、B2组各指标分别较A1、B1组明显增高（P〈0．05），C2a组仅外膜层各指标明显高于C1a组（P〈0．05），而C2b组各层各指标明显高于C1b组（P〈0．05）。结论3种不同断流术式术后1个月食管下段血管特异因子表达均下降，说明各断流术式近期可使食管下段血管减少，其中以吻合器断流术效果最为明显。术后6个月，传统断流术及选择性断流术食管下段血管特异因子表达升高，而经腹吻合器门奇断流术吻合口上方黏膜下层和固有层食管下段血管特异因子表达无明显变化，表明后者术后吻合口上方食管下段血管再生明显低于其他断流术式。

Objective To explore the effect on blood vessel regeneration of distal esophagus in canines of portal hypertension with liver cirrhosis after different procedures with paraesophagastric devascularization. Methods Portal hypertension models were produced in canines by subcutaneous injection of 60% CCl4 combined with food restriction. Forty eight model canines were randomly divided into 4 groups：group A, traditional paraesophagastric devascularization; group B, selective paraesophagastric devascularization; group C,paraesophagastric devascularization plus distal esophageal transaction and reanastomosis with stapier;group D ,control group. Every group had 12 canines which were randomly divided into A1, B1, C1, D1, A2,B2,C2 and D2 groups after the operation. Canines in groups A1 ,B1 ,C1 and D1 were executed at first month after the operation,and those in groups A2,B2, C2 and D2 were executed at the 6th month after the operation. The distal esophagus was segmented when the canines were executed. The upside and downside of the stoma in group C were distinguished and signed as Ca and Cb. Immunohistochemical methods were used to detect VEGF,CD34 and FⅧ-Rag,blood vessel-related factors,in lower esophagus. Results The expression levels of VEGF and CD54 MVD,FⅧ-Rag MVD in groups A1 ,B1 and C1 were lower than those in group D1 one month after the operation （P 〈 0.05）. All the indices in group B1 were lower than those in groups A1 and Clb,but higher than those in group Cla （P 〈0.05）. The indices in group Cla were lower than those in group C1 b （P 〈 0.05 ）. The indices in groups A2 and B2 were higher than those in groups A1 and B1, respectively at the 6th month after the operation （P 〈0.05 ）. They were higer in outer membrane in group Cla than in group C2a （P 〈0.05 ）. The indices in group C2b were higher than those in group Clb （P 〈0.05）.Conclusion At the first month after operation, the expression of blood vessel-related factors was declined in three different procedures of paraesophagastric devascularization,which indicated that all three different procedures could diminish the vessels in distal esophagus. The effect in group C was most obvious among all groups. At the 6th month after traditional paraesophagastric devascularization and selective paraesophagastric devascularization,the expression of blood vessel-related factors in distal esophagus was declined. But there were no significant changes in the expression of blood vessel-related factors in distal esophagus after paraesophagastric devascularization plus distal esophageal transaction and reanastomosis with stapler. It indicated that the blood vessel regeneration in paraesophagastric devascularization plus distal esophageal transaction and reanastomosis with stapler was inferior to that in other procedures.