肝切除术后早期应用生长抑素对门静脉血流动力学的影响

Effects of somatostatin on portal vein hemodynamics in the early stage after hepatectomy

目的:探讨肝切除术后早期应用生长抑素对门静脉血流动力学的影响及可能机制.方法:将32只健康家兔随机分为:A组(正常对照组)、B组(生理盐水治疗组)和C组(生长抑素治疗组).对A组建立门静脉置管动物模型;B组和C组均建立50%肝切除及门静脉置管动物模型,并于术中及术后早期分别滴注生理盐水和生长抑素.定期(0.5、1、2h)检测上述3组动物模型门静脉压力差值,用超声多普勒检测动物模型门静脉血流方向、血管内径、截面积、平均血流速率及血流量,同时检测动物模型肝功能变化.结果:动物模型在肝切除术后门静脉压力升高,与A组相比,B组门静脉压力升高幅度明显高于C组(0.5h:436.001±169.654Pavs258.012±167.497Pa,P<0.05;1h:394.324±163.182Pavs224.767±164.653Pa,P<0.05;2h:193.092±154.356Pavs351.861±183.579Pa,P<0.05).术中及术后早期检测A、B、C3组动物门静脉血管内径和截面积无明显差异,但C组门静脉平均血流速率及血流量显著低于A组和B组(均P<0.001).肝切除术后2h,B组与C组间ALT、AST差异无显著意义.结论:肝部分切除术后,早期应用生长抑素可降低门静脉压力的升高幅度,这种作用可能与生长抑素降低了门静脉血流速率和血流量相关.

AIM： To investigate the effects of somatostatin on portal vein hemodynamics in the early stage after hepatectomy and explore the mechanism under such effects.METHODS： Thirty-two rabbits were randomly divided into three groups： group A （n = 6, control group）, group B （n = 13, normal saline treatment group） and group C （n = 13, somatostatin treatment group）. Rabbits in all three groups underwent portal vein catheterization, while only those in Groups B and C underwent 50% partial hepatectomy. An intraoperative and postoperative intravenous infusion of normal saline and somatostatin was given. Before and after the treatment （0.5, 1, 2 h）, the pressure, flow direction, diameter, hemokinetic velocity, average flow rate and blood flow of the portal vein were detected and compared. RESULTS： After hepatectomy, the portal pressure increased. The increase in the portal pressure in group B was significantly higher than that in group C （0.5 h： 436.001 ±169.654 Pa vs 258.012 ± 167.497 Pa, P 〈 0.05; 1 h： 394.324 ± 163.182 Pavs 224.767 ± 164.653 Pa, P 〈 0.05; 2 h： 193.092 ± 154.356 Pavs 351.861 ±183.579 Pa, P 〈 0.05）. There were no significant differences in portal diameter and hemokinetic velocity among all the three groups before and after treatment （P 〉 0.05）. However, the average flow rate and blood flow of the portal vein in group C were significant lower than those in groups A and B （both P 〈 0.05）. Two hours after hepatectomy, no significant differences in the expression of ALT and AST were noted between groups A and B. CONCLUSION： Application of somatostatin in the early stage of hepatectomy may reduce elevated portal pressure, which may be associated with somatostatin-induced decrease in flow rate and blood flow of the portal vein.