猪肝脏灌注异常现象的相关机制

Etiopathogenesis of hepatic perfusion disorders:an experimental study in pigs

目的通过对猪正常肝脏建立灌注异常模型,探讨肝灌注异常的发生因素。方法9头实验用小型猪进入研究,随机平均分为A、B、C3组,分别采用明胶海绵碎屑进行肝内门静脉、肝动脉、肝静脉分支栓塞,术后即刻及1周后进行CT增强扫描,观察是否存在肝灌注异常现象。结果术后即刻CT扫描,全部研究对象出现肝灌注异常现象,表现为动脉期肝实质内出现楔形或不规则形一过性强化,门静脉期恢复正常。A组出现灌注异常的部位与栓塞血管所在肝段、叶一致;B组栓塞区出现低灌注区,非栓塞区出现一过性强化现象。C组2头出现灌注异常的部位与栓塞区域一致,1头比栓塞区域大。1周时CT复查,除C组存在部分灌注异常现象外,A、B组灌注异常现象消失。结论肝内门静脉、肝动脉、肝静脉分支堵塞是造成肝灌注异常现象的因素。

Objective To explore the causes of hepatic perfusion disorders （HPD）, and to analysis the CT features of this phenomenon. Methods Nine experimental pigs were randomly divided into three groups. In Group A, B and C, intrahepatic portal, arterial branches and hepatic vein were selectively embolized, respectively. Then all animals underwent contrast enhanced CT scans immediately and after one week. Results On CT images immediately after intervention, HPD were found in all animals. Multiple transient wedge-shaped hyperattenuation represented during the hepatic arterial phase and isoattenuating areas during the portal venous phase. In group A, the site of HPD was in correspondence with the area of embolization, whereas in group B, the embolized area displayed hypoattenuation and non-embolized area displayed hyerattenuation during arterial phase. In group C, the site of HPD was correspondence with the area of embolization in two pigs, but in one pig, the region of HPD was larger than the region of embolization. After one week, HPD disappeared due to sponges absorption and the vessels reopening in group A and B. In group C which hepatic vein was coagulated by laser, HPD remained partially. Conclusion Intrahepatic vascular occlusions of portal, hepatic arterial and hepatic venous branches are the main factors that cause HPD.