两种入肝血流阻断方式对硬化肝脏再灌注损伤的比较研究

Comparison of portal vein clamping without hepatic artery inflow control and intermittent hepatic inflow occlusion on cirrhotic liver of rat

目的:比较保留肝动脉持续门静脉阻断方式与间断肝门阻断方式对硬化肝脏的再灌注损伤。方法:四氯化碳诱导肝硬化大鼠随机分为3组:假手术对照组(SO);保留肝动脉持续门静脉阻断组(PVC);间断肝门阻断组(IC)。分别检测肝脏血流阻断45 min后复流1、6、24 h血清AST含量,行肝血流复流后吲哚青绿15 min滞留试验(ICGR15)及行组织形态学、超微结构观察。结果:肝血流复流1、6、24 h PVC组和IC组血清AST分别为607±322、791±119、375±136 IU/L和547±273、864±241、449±131IU/L,均高于SO组的188±52IU/L,3组比较差异有统计学意义(F=6.81,44.03,11.38;P<0.05),PVC组和IC组差异无统计学意义。肝血流复流1、6、24 h,PVC组及IC组ICGR15分别为(23±9)%、(19±6)%、(18±3)%和(54±9)%、(38±6)%、(29±3)%,均高于SO组的(16±4)%、(14±3)%、(15±3)%,3组比较差异有统计学意义(F=57.84,42.41,37.15;P<0.05),其中IC组最高。病理组织学检查示PVC组及IC组肝血流复流后肝组织发生点状及小片状坏死,两组间病变程度相似;超微结构显示IC组较PVC组线粒体数目增多、肿胀,部分线粒体破裂溶解。结论:与间断肝门阻断方式相比,保留肝动脉持续门静脉阻断方式对硬化肝脏功能影响更小,具有较好的临床应用前景。

Objective： To compare the protective effect of portal vein clamping without hepatic artery inflow control and intermittent portal pedicle clamping on cirrhotic liver after ischemia and reperfusion.Methods： Cirrhotic rats induced by carbon tetrachlorideand were randomly assigned into 3 groups of the the cirrotic sham operation（SO）,the portal vein clamping without hepatic artery inflow contro（l PVC）and the intermittent portal pedicle clamping（IC）.At 1h,6h and 24h post reperfusion,the serum AST,the indocyanine green retention rate at 15 min after injection（ICGR15）and the morphology and ultrastrcture changings were evaluated.Result： At 1h,6h and 24h post reperfusion,the AST levels of group PVC and group IC were higher than SO,but no difference was observed between PVC and IC.The ICGR15 ranked as follows： group SO group PVC group IC.No difference was observed between the group PVC and group IC on histopathology and the injury of ultrastructure in group IC was more serious than those in group PVC,which performanced as increasing in the number of mitochondria,swelling,and dissolution of some mitochondrial rupture.Conclusion： The portal vein clamping without hepatic artery inflow control is better than the intermittent portal pedical clamping in influencing the liver function.