入肝门静脉动脉化加门腔分流术对肝硬化大鼠血流动力学的影响

Hymodynamics study in rats with liver cirrhosis after portal vein arterialization associated with portocaval shunt

目的对肝硬化大鼠利用右肾动脉行入肝门静脉动脉化+门腔分流术,研究该术式对肝硬化大鼠门静脉血流动力学的影响。方法四氯化碳(CCl4)诱导肝硬化大鼠成模后,分为A组(动脉化组)15只,利用右肾动脉行门静脉动脉化+门腔分流术,B组(对照组)10只,单纯行右肾切除及门静脉阻断10min后关腹。术后即刻、术后1月和术后3月分别检测门静脉压力、内径和血流量。结果术后即刻、术后1月和术后3月A组大鼠与B组相比,入肝门静脉压力和入肝血流量明显升高,随时间推移入肝门静脉压力有下降趋势,但仍高于对照组(P<0.01),而入肝血流量则持续增加,明显高于对照组(P<0.01)。入下腔静脉门静脉压力则明显下降并维持在较低压力水平(P<0.01)。术后A组入肝门静脉内径较B组门静脉内径明显增宽(P<0.01),但术后1月至3月入肝门静脉在适应压力变化后,内径趋稳在一定水平。结论门腔分流术对肝硬化大鼠可以有效降低门静脉循环压力,减少静脉曲张出血的危险性;进一步行入肝门静脉动脉化则可有效增加入肝血流量,入肝门静脉压力及血流量随时间推Σ可在较高水平取得新的平衡。

Objective To investigate the effect of portal vein arterialization（PVA） associated with portacaval shunt on hepatic hemodynamics. Methods Twenty-five Sprague-Dawley rats with liver cirrhosis were divided into two groups randomly. Group A（ PVA group） ： to establish the PVA model by the fight renal artery after portacaval shunt. Group B（control group）： right nephrectomy and temporary occlusion of portal vein for 10 minutes. The pressure, diameter and blood inflow of portal vein were investigated at the end of operation, 1 month and 3 month after operation, respectively. Results In group A, the pressure, diameter and blood inflow of portal vein increased significantly after surgery. The portal vein pressure fell slowly with the passage of time, but were still significantly higher than group B within 3 postoperative months. The diameter and hepatic blood inflow was risen significantly after surgery, and continued within 3 months. However, there was no significantly difference between the postoperative 1 month and 3 month of the diameter. At 3 postoperative month, the hepatic blood inflow was markedly higher than 1 postoperative month. The pressure of the caval inflow portal stem decreased obviously after surgery. Conclusions PVA associated with portocaval Shunt reduce the pressure of portal system collateral circulation effectively, minimize the risk of hemorrhage, furthermore the hepatic blood inflow was increased significantly, hence improve the blood and oxygen supply. The pressure and diameter of the portal vein achieve a new balance at a high level and become stable within 3 months after surgery.