兔小肝综合征动物模型的建立

Establishment of the small-for-size syndrome model in the rabbits

目的 在对日本大耳兔肝脏进行解剖学研究的基础上,采用不同比例肝叶切除术的方法建立兔小肝综合征（SFSS）动物模型.方法 对20只兔进行肝脏在体/离体解剖学和门静脉/肝静脉铸型标本观察,测定各肝叶质量并计算各肝叶质量百分比.将44只兔随机分为5组,分别为：假手术组（n=4）；A组（n=10,切除“左中叶＋右中叶”）；B组（n=10,切除“左外叶＋左中叶＋右中叶”）；C组（n=10,切除“尾状叶＋左中叶＋右中叶＋右外叶”）；D组（n=10,切除“左外叶＋左中叶＋右中叶＋右外叶”）.采用原位无血切肝技术切除肝叶,观测术后一般情况、生存时间、肝功能和兔肝病理学改变.结果 兔肝叶形态、比例相对恒定,肝裂深,各肝叶均有相对独立的Glisson系统和肝静脉回流系统,易于通过结扎肝蒂行部分肝叶切除术.按照不同肝叶组合,A、B、C、D4组保留肝叶比例分别约为50％、28％、25％、6％,术后1周存活率分别为100％、50％、20％和0％.术后肝功能测定A组谷丙转氨酶（ALT）、总胆红素（TB）水平及凝血酶原时间（PT）与对照组比较差异无统计学意义（P＞0.05）；B、C两组术后则明显高于假手术组和A组,均于术后3d达到峰值,之后缓慢下降,至术后7d仍高于正常值水平（P＜0.05）.术后自然死亡和术后7d处死兔的病理学观察,A组肝再生明显；B、C两组死亡兔表现为余肝淤血、淤胆,肿胀、坏死,以及胃肠道淤血和腹水,存活至7d兔表现为余肝组织明显增生肥大.结论 兔体积适中,围手术期管理和手术操作相对简便,其肝脏解剖学特点适宜制作部分肝切除术SFSS模型,当保留“肝左外叶”或“肝右外叶＋尾状叶”时,余肝比例约为25％和28％,可表现为典型的SFSS.

Objective To establish a small-for-size syndrome model by different proportional liver resection with the investigation on the anatomical features of Japanese rabbits＆#39; liver.Methods We observed 20 rabbits＆#39; livers by anatomic methods through in vivo and in vitro with the portal yein and the hepatic vein pipeline cast specimens.Every lobe was weighed and the proportions were calculated.Forty-four rabbits were randomly divided into 5 groups：the control group （n =4）,group A （n =10,receiving hepatectomy with “left medial lobe and right medial lobe”）,group B （n =10,receiving hepatectomy with “left lateral,medial lobe and right medial lobe”）,group C （n =10,receiving hepatectomy with “caudate lobe,left medial lobe and right lateral,medial lobe”）,group D （n =10,receiving hepatectomy with “left lateral,medial lobe and right lateral,medial lobe”）.Partial hepatectomy in vivo was conducted using bloodless liver resection and the general state after the operation,survival time,hepatic function and the pathologic changes of the remnant liver were observed.Results The shape and weight ratio of each lobe kept relatively constant and had obvious hepatic fissures.Each lobe had independent Glisson system and hepatic vein system,so partial hepatic lobectomy could be performed easily after ligation of pedicles.According to different combinations of hepatic lobes,groups A,B,C and D had separately left approximately 50%,28%,25%,and 6% hepatic lobes,and the one-week survival rate after hepatectomy was 100%,50%,20%,and 0% respectively.There was no significant difference in ALT,TB and PT between group A and control group （P 〉 0.05）,but ALT,TB and PT levels in groups B and C were significantly higher than in control group and group A,reached their peaks on the 3rd day,then began a slow decline,and still above the normal values on the seventh day （P 〈 0.05）.The pathological observation on the liver tissue from the animals with natural death and those sacrificed at 7th day after surgery showed that liver regeneration was obvious in group A,but congestion and cholestasis of the remnant liver,swelling and necrosis,gastrointestinal congestion and ascites were observed in groups B and C of those natural deaths,and hyperplasia and hypertrophy were significantly observed in those sacrificed at 7th day.Conclusion The rabbit＆#39; s size is moderate and it＆#39; s relatively simple in perioperative management and surgery.The characteristics of liver anatomy are suitable for preparing the partial hepatectomy of SFSS model.When retaining the left lateral lobe or “the right lateral lobe and caudate lobe” about 25% and 28% of the whole liver,the typical characteristics of SFSS are presented.