肝门区域低温冷冻的实验效应

THE EXPERIMENTAL EFFECTS OF FREEZING THE AREA OF FIRST PORTA HEPATIS IN PIGS

为深入研究低温对肝门区域组织及Glisson管道的影响 ,将 16只小猪随机分为 2组 ,用冷冻头对实验组第一肝门部进行 3min的深低温冷冻 ,对照组仅阻断肝门 3min。术后通过血清学、核素扫描、彩色多谱勒和病理学等方法反映肝组织及管道系统变化。结果显示 ,动物肝门部的胆管系统在冷冻后出现严重损伤 ,表现为进行性、不可逆的胆管坏死、狭窄、胆瘘及化脓性胆管炎等并发症 ,肝门部较大坏死物质也会对门静脉造成压迫。提示如对第一肝门部进行直接深低温冷冻 ,应注意保护胆管系统。

To investigate the effects of freezing the area of first porta hepatis which involves Glisson duct system,16 pigs were randomly divided into 2 groups. Group A:structures of the first porta hepatis were frozen by a dish-like cryoprobe (D=3.0cm) with temporary blockage of hepatic portal blood during freezing,the temperature at the end of 1,2,3minutes of cryotherapy was -50℃,-110℃,-131℃.Group B:sham operation,only with hepatic portal blockage for 3 minutes. Liver function tests, 99mTc-EHIDA scintiscanning,and pathological observation were used to evaluate the effects of the cryosurgery postoperatively.The results showed that the bile duct systems on first porta hepatis were severely destroyed by the cryosurgery,the cryoimpairment of common bile duct and/or common hepatic duct led to complications of progressive, irreversible, cryptic necrosis, fistula and pyogenic angiocholitis. The large freezing necrotic lesion in the porta hepatis might compress the portal vein. The perfect protection of biliary system should be accomplished in the cryosurgery of the first porta hepatis to avoid severe complications.