肝动脉/门静脉早期复流对肝移植大鼠小肠缺血再灌注损伤的影响

Influences of hepatic artery/portal vein early reflow on rat intestinal ischemia/reperfusion injury following liver transplantation

背景:当肝动脉与门静脉早期复流时序不同时,是否会加重对肝移植大鼠小肠缺血/再灌注的损伤尚未见大量报道。目的:探讨肝动脉与门静脉早期复流对肝移植大鼠小肠缺血/再灌注损伤的影响。方法:采用门静脉灌注的大鼠自体肝移植模型,78只SD大鼠以简单随机化法分为3组:肝动脉组(n=36):行自体肝移植手术,以40C乳酸林格液由门静脉灌肝40min,开放肝动脉及下腔静脉,10min后开放门静脉;门静脉组(n=36):行自体肝移植手术,门静脉开放恢复肝脏血流后10min再开放肝动脉血流;假手术组(n=6):打开腹腔,游离肝脏后关腹。观察各组小肠显微及超微结构变化并测定一氧化氮水平。结果与结论:术后各实验组不同时段先后出现小肠绒毛排列不整或紊乱,小肠黏膜细胞线粒体大小不一,明显肿胀,呈类圆形,内有空泡变性,严重者可见嵴减少、断裂或消失。小肠组织一氧化氮水平均升高。上述变化在术后12h达高峰。术后肝动脉先复流组小肠显微及超微结构损伤及小肠组织一氧化氮水平明显高于门静脉先复流组。提示,肝动脉早期复流可以通过早期肝脏供氧以减少移植肝脏的损害,但门静脉的延迟开放则加重了肝移植大鼠小肠的缺血/再灌注损伤。

BACKGROUND：It remains unclear that whether different time sequence of hepatic artery/portal vein early reflow can aggravate the intestinal ischemia/reperfusion（I/R） injury following liver transplantation.OBJECTIVE：To investigate the influence of hepatic artery/portal vein early reflow on rat small bowel I/R injury after liver transplantation.METHODS：Rat liver transplantation models with portal vein infusion were selected.A total of 78 SD rats were randomly divided into the 3 groups.The hepatic artery group（n=36）：rats were underwent liver transplantation,and received infusion via portal vein using 40 C Ringer lactate solution,opened hepatic artery and inferior vena cava,followed by open portal vein 10 minutes later;the portal vein group：rats were underwent liver transplantation,open the hepatic artery at 10 minutes after portal vein;the sham-surgery group received abdominal cavity exposure and liver liberation.The microstructure and ultramicrostructure changes of the small bowels were observed,and the level of the nitric oxide（NO） was determined.RESULTS AND CONCLUSION：In each group at different periods after operation,the villi had occurred malposition or disorder.The mitochondria size of mucous membrane of small intestine cell were not the same,and engorged obviously,were almost buninoid,vacuolar degeneration were inside.The cristae of mitochondria were decreased,collapsed or disappeared.The NO level of small intestine tissue was raised.These changes reached the peak at 12 hours after operation.Compared with the portal vein group,the injury of microstructure and ultramicrostructure of small bowel and NO level of small intestine tissue of the hepatic artery group were higher.Through early oxygen supply of liver,hepatic artery early reflow can reduce transplantation liver damage,the delay in opening the portal vein increased small intestine of I/R injury of liver transplantation in rats.