大鼠自体肝移植中暂时性门体分流对肝脏的保护作用

Protective effect of temporary portocaval shunt on the liver during orthotopic liver autotansplatation in rats

目的比较门静脉分流和阻断对大鼠缺血-再灌注(I-R)后肝脏的影响。方法将大鼠分为对照组、分流组和阻断组,制作门颈静脉转流下大鼠自体肝移植模型,观察术后肝脏组织学变化及肝细胞凋亡情况。结果 (1)分流组术中大鼠胃肠及脾脏无淤血,术后大鼠约2 h后可站立,24 h后能自由饮食及活动;而阻断组大鼠可见脾脏明显淤血,术后大鼠精神差,恢复时间延长。(2)分流组大鼠术后6 h部分肝细胞变性坏死,肝脏组织内炎症细胞浸润,肝小叶结构基本完整,术后24 h肝脏组织病理损伤好转,至术后3 d基本恢复正常。阻断组大鼠术后6 h可见广泛肝细胞变性坏死,部分肝小叶组织结构破坏,术后3 d起肝脏组织病理损伤逐渐好转,至术后第7天基本恢复正常。(3)两组肝细胞凋亡数于再灌注24 h达到高峰,分流组肝细胞凋亡数目于再灌注各时间点均显著少于阻断组(P<0.05)。结论无肝期门体分流处理可以避免门静脉阻断引起的胃肠、脾脏淤血,在更大程度上保持肝移植后肝脏组织结构完整性,减少肝细胞凋亡。

Objective To compare the effects of temporary portal-cervical bypass and portal vein oclusion on the liver with ischemia-reperfusion（I-R） injury in rats undegoing orthotopic liver autotansplatation（OLAT）.Methods After the OLAT rat models with portal-cervical bypass（group A） or portal vein oclusion（group B） were established,the liver histologcal changes and cell apoptosis were observed,which were compared to the normal rats（group C）.Results Compared to group C,the rats in group B showed marked poor spirit,congestion of gastrointestines and spleen,and pathologically destroyed hepatic lobule structure and necrosis at 6h after I-R,which recoverd to nearly normal on the 7th day after surgery.Compared to group B,the changes above were much lighter and the hepatic pathological changes recoverd to nearly normal on the 3rd day after surgery in group A.Hepatic cell apoptosis was less in group A than that in group B（P0.05）.Conclusion The portocaval shunt method during liver-free period may reduce the congestion of gastrointestines and spleen,promote the recovery of liver structure and reduce hepatic cell apoptosis in the rats undergoing OLAT.