肝切除时门静脉血部分动脉化的研究

Study on partial portal arterialization in hepatectomy

目的 研究犬门静脉血部分动脉化的肝保护作用。方法 建立犬保留肝 (占全肝60 % )暂时性血流阻断、肝固有动脉切断并切除未阻断肝的急性肝衰模型 (对照组 ) ,并行肝总动脉与胃十二指肠静脉吻合 (A P组 ) ,观察生存率并定时测定丙氨酸转氨酶 (ALT)、动脉血酮体比 (AKBR)及肝动静脉、门静脉血气分析。结果 对照组 7d生存率为 37.5% ,A P组则达 75.0 % (P <0 .0 5) ,ALT及AKBR在A P组均较对照组差异有非常显著性 (P <0 .0 1 ) ,门静脉和肝静脉血氧分压均较术前增高 ,对照组则显著降低 (P <0 .0 1 )。结论 门静脉血部分动脉化能有效预防犬肝血流阻断。

Objective\ To study the hepatic protective effect of partial portal arterialization in dogs undergoing partial ischemia of the remnant liver, dissection of the hepatic artery and 40% hepatectomy. Methods\ Sixteen mongrel dogs were divided into two groups: hepatic ischemia and dissection of the hepatic artery and hepatectomy were performed in the control group. In the arterio portal shunt group (A P group), A P shunt was made between the common hepatic artery and gastroduodenal vein before hepatectomy. The survival rate was observed, liver function and arterial ketone body ratio (AKBR) were regularly determined and blood gas analysis carried out. Results\ In control group, survival rate was 37.5% on the 7th day. However, in A P group, 75.0% dogs survived ( P <0.05). ALT, AKBR and oxygen partial pressure of portal vein and hepatic vein were significantly improved in A P group as compared with those in control group ( P <0.01). Conclusion\ Partial portal arterialization can effectively prevent liver from acute failure through increase of oxygen supply to the remaining liver after partial ischemia and hepatic resection.\;