肝切除联合肝动脉切除对梗阻性黄疸大鼠肝细胞再生和凋亡的影响

Influence of partial hepatectomy with hepatic artery resection on liver regeneration and hepatocyte apoptosis in rats after obstructive jaundice

目的 探索在梗阻性黄疸时，不同范围肝切除联合肝动脉切除对肝细胞再生和凋亡的影响。方法155只雄性SD大鼠行胆总管结扎制备梗阻性黄疸模型，5d后二次手术分为：胆肠再通内引流组；肝切除（42％、70％）联合胆肠再通内引流组；肝切除（42％、70％）联合肝固有动脉切除、胆肠再通内引流组。动态观察二次手术后24h、72h、7d肝组织HGF、bcl-2mRNA含量及蛋白表达、肝细胞增殖和凋亡指数的变化，并统计各组死亡率。结果高胆红素血症、行胆肠再通内引流的同时，大鼠肝切除或肝切除联合肝动脉切除后，肝再生均受抑制，凋亡增多；较之肝切除组和42％肝切除联合肝固有动脉切除组，70％肝切除联合肝固有动脉切除组术后肝组织HGF、bcl-2mRNA含量显著减少，肝细胞再生明显受抑而凋亡显著增多，死亡率显著增高（P＜0．05）。结论高胆红素血症时，肝切除量是影响大鼠肝切除联合肝动脉切除实施安全性的重要因素，42％肝切除联合肝固有动脉切除、胆肠再通内引流，对肝细胞再生和凋亡影响较小，安全可行；70％肝切除联合肝动脉切除、胆肠再通内引流后肝细胞再生显著受抑制，凋亡增多，死亡率高，应避免实施。

Objective To study liver regeneration and hepatocyte apoptosis in the obstructive jaundice liver after partial hepatectomy （PH） at different volumes with hepatic artery resection （HAR）. Methods One hundred fifty five male SD rats which underwent common bile duct ligation （CBDL） for 5 days were randomized into following groups： the bile duct obstruction and reperfusion of bile flow （BDO-RBF） group, 42% PH with BDO-RBF group, 70% PH with BDO-RBF group, 42% PH with HAR and BDO-RBF group and 70% PH with. HAR and BDO-RBF group. The levels of HGF, bcl-2 mRNA and protein, hepatocyte proliferation/apoptosis index in hepatic tissues were dynamically observed after operation （24 h, 72 h and 7 d）. Mortality was calculated. Results Compared with other groups, hepatocyte proliferation /apoptosis index and the HGF, bcl-2 mRNA content of liver tissue in 70% PH with HAR group were aggravated and had a significantly increased mortality on in rats after obstructive jaundice （P〈0.05）. Conclusion （1）Both the liver regeneration and apoptosis are influenced by conspicuous bilirubinemia, hepatectomy and hepatic artery resection in rats after obstructive jaundice, especially by the liver resection volume and conspicuous bilirubinemia. （2） Under the condition of conspicuous bilirubinemia, the influence of 70% PH with HAR on liver regeneration and apoptosis is severer than its counterpart of 42% in the rats. Thus, the former is not safe and should be avoided and the later can be used.