肝脏手术中肝门阻断对肺脏影响的实验研究

Influence of hepatic inflow occlusion on postoperative lung injury in rabbits

目的 探讨肝脏手术时肝门阻断对肺脏的影响及其可能机制。方法 选用 30只实验家兔 ,雌雄均衡 ,随机分成 4组 ,假手术对照组 (S组 :10只兔 ) ;全肝门阻断无再灌组 (N组 :5只兔 ) ;部分肝门阻断再灌组 (L组 :5只兔 ) ;全肝门阻断再灌组 (D组 :10只兔 )。分别检测各组血及肺组织中丙二醛 (MDA) ,血栓素B2 (TxB2 )含量 ,并通过光学显微镜和电子显微镜观察组织学改变和PMN计数。结果 ( 1)N组血MDA、TxB2 明显增高 (与S组比较 ,P <0 0 5 )。 ( 2 )N组组织PMN无明显增高 (与S组比较 ,P >0 0 5 ) ,D组、L组肺PMN计数明显增高 (与S ,N组比较 ,P <0 0 5 ) ,D组与L组间无明显差异 (D ,L间比较 ,P >0 0 5 )。 ( 3)光镜观察S组及N组肺组织形态学均正常。D组或L组肺组织可见灶性充血、PMN聚集。除PMN增多外 ,还可见肺组织中巨噬细胞增多等改变。电镜观察S组及N组肺组织超微结构均正常。未见明显缺血改变 ,如实质细胞线粒体肿胀、空泡样改变或内皮细胞连接及基膜改变等。D、L组均可见肺组织灶性实质细胞线粒体空泡样改变 ,毛细血管腔内WBC出现机率增多 ,肺泡Ⅱ型细胞分泌颗粒 (板层小体 )减少 ,肺泡腔内巨噬细胞增多以及毛细血管内血小板聚集等。

Objective Hepatic inflow occlusion is the main methods for prevention of bleeding during liver operation. It may be the main reason of postoperative lung complication or adult respiratory depression syndrome (ARDS). The present study is to explore the influence of hepatic inflow occlusion on lungs. Methods Anesthetized rabbits (n=30) were randomized into four groups: Sham operation (S group, n=10); Reperfusion (D group, n=10); Left lateral reperfusion (L group, n=5); Non reperfusion (N group, n=5). The contents of malondialdehyde (MDA), thromboxane (TxB 2) in blood and lung tissue were determined; histological change in lung tissue was observed by optical microscope (OM) and electronic microscope (EM). Results (1) The contents of MDA and TxB 2 in blood were significantly higher in N group than that in S groups (P>0 05), but no difference in lung tissue between N and S groups (P>0 05); in D group, the contents of MDA and TxB 2 in blood and tissue were both significantly higher than that in N or S group (P<0 05), no difference bwtween D and L groups P>0.05). (2) PMN was significantly higher in D and L groups than that in S or N group (P<0.05). (3) The structure of cell organelles was normal in S and N groups on EM, but some vacuolar changes in mitochondria in parechyma cells were found in both D and L groups on EM. Conclusions (1) Hepatic inflow occlusion can make influence on lungs mainly by reperfusion. (2) The influence of hepatic inflow occlusion on lungs may be mediated by MDA, TxB 2 and PMN.