大鼠小体积肝移植肝动脉重建的意义探讨

Significance of arterial reconstruction on the model of small-for-size orthotopic liver transplantation in rats

目的:探讨肝动脉重建在大鼠小体积肝移植中的意义。方法:采用改良二袖套法建立大鼠40%小体积肝移植模型,实验分动脉重建组和动脉未重建组,观察1周生存率,并于术后1、2、4、7天检测肝功能、移植肝组织学变化和免疫组化法检测肝细胞的增殖细胞核抗原(PCNA)。结果:动脉重建组1周生存率为66.7%,动脉未重建组1周生存率为50.0%(P>0.05)。丙氨酸氨基转移酶(ALT)和总胆红素(TB)术后第1天即开始明显增高,第2天达高峰,以后逐渐降低,动脉未重建组和动脉重建组各时间点相比较,TB第2、7天高于动脉重建组,ALT第2、4天高于动脉重建组,差异有显著性(P<0.05)。动脉重建组术后中央静脉及肝窦扩张程度相对较轻,可见较多二倍体和多倍体肝细胞。PCNA表达于术后第2天最高,动脉重建组术后第1天的移植肝细胞PCNA阳性表达率高于动脉未重建组,而术后第7天移植肝细胞PCNA阳性表达率低于动脉未重建组,差异有显著性(P<0.05)。结论:肝动脉重建可明显改善大鼠小体积移植肝的功能,促进移植肝的再生,有效地保护移植肝的组织学结构,减轻术后移植肝的组织学改变,动脉化模型术后早期增殖较静脉化模型活跃。

Objective：To investigate the significance of arterial reconstruction on the model of 40% small-for-size orthotopic liver transplantation in rats. Methods：Modified two-cuff technique was applied to establish a rat model of 40% orthotopic liver transplantation. A total of 192 sprague dawley （SD） rats were randomly divided into 2 groups：small-for-size orthotopie liver transplantation with arterial reconstruction group （A group） and small-for-size orthotopic liver transplantation without arterial reconstruction group （B group）. One week survival rate, main indexes of liver function,histology and the expression of the proliferative cell nuclear antigen （PCNA） of liver graft by immunohistochemical method were detected on the 1st, 2nd,4th and 7th day after transplantation,respectively. Results： One week survival rate of A group and B group were 66.7% and 50.0%,respectively （P 〉 0.05）. Alanine aminotransferase （ALT） and total bilirubin （TB） began to elevate from the first day and peaked on the second day after surgery. ALT in B group on the second and fourth day were higher significantly than those in A group （P 〈 0.05）. TB in B group on the second and seventh day were higher significantly than those in A group （P 〈 0.05）. Histological findings indicated that more diploid and polyploid hepatoeytes could be seen in A group. The expression of PCNA of liver graft peaked on the 2nd day after surgery. The expression of PCNA in A group was higher on the 1st day and lower on the 7th day than that in B group after operation （P 〈 0.05）. ConClusion：Arterial reconstruction can improve liver function of liver grafts after small-for-size orthotopic liver transplantation, and alleviate the histological changes and promote the regeneration of liver grafts quickly.