门静脉动脉化对扩大肝-胆切除术后肝脏储备功能的影响

Effect of portal vein arterialization on hepatic functional reserve following hepato-biliary resection in miniature pigs with obstructive jaundice

目的观察慢性、梗阻性黄疸小型猪肝-胆切除术联合限流性部分门静脉动脉化（PPVA）术后肝脏储备功能的动态变化。方法利用梗阻性黄疸小型猪模型，模拟进行联合半肝切除的肝门部胆管癌扩大根治性手术。实验分组：无黄疸对照组（A组，n=4）、门静脉动脉化组（B组，n=4）及非门静脉动脉化组（C组，n=4）。对照观察根治术中应用限流性PPYA在术后30d内的吲哚菁绿15min滞留率（ICGl5），从而判断肝脏储备功能的动态变化。结果术前B、C组高于A组[（0．66±0．07）％、（0．64±0．09）％比（0．09±0．01）％，P〈0．01]，术后第1天B组低于C高于A组[（0．59±0．11）％比（0．82±0．09）％、（0．18±0．04）％，P〈0．05、P〈0．01]，术后第7天B组高于A组低于C组[（0．34±0．09）比（0．17±0．04）％、（0．69±0．11）％，P均〈0．05]。术后第30天B组低于C组、与A组差异无统计学意义[（0．12±0．03）％比（0．22±0．03）％、（0．09±0．003）％，P〈0．01、P〉0．05]。B组术后第7天低于术前[（0．34±0．09）％比（0．66±0．07）％，P〈0．01]。结论限流性PPVA可促进慢性梗阻性黄疸小型猪肝-胆切除术后残肝储备功能的恢复。

Objective To investigate the change of hepatic functional reserve （HFR） after flowcontrolled partial portal vein arterialization （PPVA） in hepato-biliary resection （HBR） in miniature pigs with obstructive jaundice. Methods Eight miniature-pig models with chronic gradually obstructive jaundice were divided into 2 groups with 4 pigs each ： PPVA group （group B, n = 4）, non-PPVA group （ group C, n = 4）, and another 4 pigs without chronic gradually obstructive jaundice served as control group （ group A, n = 4）. Approaches of EHBR with or without PPVA were done, then the effects of flow-controlled PPVA on HFR of remnant liver were studied by detecting indocyanine-green retention at 15 min （ ICG15 ） in 30 days post-operation. Results ICG15 in groups B and C was significantly higher than in group A pre-operation [ （0. 66 ± 0. 07） %, （0. 64 ± 0. 09） % vs （0. 09 ± 0. 01 ） %, P 〈 0.01 ]. ICG15 in group B was significantly lower than that in group C, and higher than in group A at the first day post-operation [ （0. 59 ± 0.11）% vs （0.82±0.09）%, （0.59±0.11）% vs （0.18 ±0.04）% ,P〈0.05,P〈0.01]. ICG15 in group B was signifieandy lower than in group C, and higher than in group A at 7th day post-operation [（0.34±0.09）% vs （0.69±0.11）%, （0.34±0.09）% vs （0. 17±0. 04）%,bothP〈0. 05]. ICG15 in group B was significantly lower than in group C, but showed no significant difference from group A at 30thday post-operation [（0.12 ±0.03）% vs （0.22 ±0.03）%, （0.12 ±0.03）% vs （0.09 ± 0. 003）% ,P 〈0. 01 ,P 〉 0. 05 ]. ICG15 in group B on the 7th day post-operation was significantly lower than that pre-operation [ （0. 34 ± 0. 09 ） % vs （0. 66 ± 0. 07 ） %, P 〈 0.01 ]. Conclusion Flow-controlled PPVA in HBR is beneficial to recovery of HFR on miniature pigs with obstructive jaundice.