第一肝门阻断对大鼠硬化肝组织超微结构的影响

Effect of Pringle manoeuvere on ultrastructure of cirrhotic liver tissue in rats

目的探讨第一肝门阻断(Pringle阻断)对硬化肝组织及其超微结构的影响。方法将四氯化碳诱导的肝硬化模型大鼠分为假手术(sham operation,SO)对照组和Pringle阻断(portal triad clamping,PTC)组,PTC组阻断45 min、复流6 h取下腔静脉血和肝组织标本,检测血中丙氨酸氨基转移酶(alanine aminotransferase,ALT)水平及肝组织中三磷酸腺苷(adenosine triphosphate,ATP)含量,制作组织病理切片及电镜切片,观察组织损伤及肝超微结构的改变。结果血液中ALT水平:SO组(117.8±58.0)IU/L,PTC组(1 147.0±297.0)IU/L,PTC组高于SO组(P<0.05);肝组织中ATP的含量:SO组(3.80±0.75)μmol/g,PTC组(1.10±0.26)μmol/g,PTC组低于SO组(P<0.05);超微结构观察SO组肝细胞线粒体轻微肿胀,而PTC组肝细胞线粒体明显肿胀,线粒体膜损伤破裂,线粒体嵴疏松溶解,肝细胞核固缩,光镜下见肝细胞片状坏死。结论大鼠硬化肝组织中肝细胞对于Pringle阻断引起的缺血损伤更为敏感,对于硬化肝应尽量缩短Pringle阻断时间。

Objective To study the effect of Pringle manoeuvere also known as portal triad clamping （PTC） on the ultrastructure of cirrhotic liver tissue.Methods Rats with tetrachloride carbon-induced liver cirrhosis were randomly divided into sham operation （SO） group and PTC group.After 45 min of ischemia and 6 h of reperfusion,blood and liver tissue samples were taken.Serum ALT and ATP levels were measured in two groups.The tissue sample was cut into sections for observing liver tissue lesions and ultrastructure under electron microscope.Results The serum ALT level was significantly higher in PTC group than in SO group （1 147.0 ± 297.0 IU/L vs 117.8 ± 58.0 IU/L,P 〈 0.05） whereas the serum ATP level was significantly lower in PTC group than in SO group （1.10 ± 0.26μmol vs 3.80 ± 0.75μmol,P 〈 0.05）.Electron microscopy showed mild hepatocytic mitochondria swelling in SO group,and severe hepatocytic mitochondria swelling,ruptured mitochondria membrane,loose and dissolved mitochondrial crista,and heptocytic karyopyknosis in PTC group.Optical microscopy showed patchy hepatocytic necrosis in PTC group.Conclusion Hepatocytes in cirrhotic tissue of rats are more sensitive to Pringle manoeuvere-induced ischemic injury,and the time of Pringle manoeuvre should be shortened as far as possible.