全肝血流阻断对胆道梗阻兔肝脏损伤的研究

The effect of total hepatic vascular exclusion on liver ischemia-reperfusion injury in rabbits with cholestasis

目的 研究全肝血流阻断对胆道梗阻兔肝脏缺血 /再灌注损伤。方法 将 30只兔随机均分为 3组 :A组 (对照组 )、B组 (胆道梗阻组 )和C组 (全肝血流阻断组 )。组织气体分析仪持续测定兔肝组织氧压 (PtiO2 ) ;光镜观察肝脏病理改变 ;全自动生化仪测定血清总胆红素 (TBIL)丙氨酸氨基转氨酶 (ALT)。结果 B、C组在全肝血流阻断后 ,肝PtiO2 值均明显下降 ,再灌注 60min后 ,肝PtiO2 值仍未恢复 ,与缺血前PtiO2 值差异有显著性 (P <0 .0 5) ,且在再灌注 60min时 ,B组较C组肝PtiO2 值恢复更慢 (P <0 .0 5) ;B、C组肝缺血再灌注 2 4h的不同时相 ,ALT值均进一步升高 ,B组较C组升高更为明显。至第 7d ,B、C两组ALT值均恢复到近于正常值 ,肝细胞损伤的病理改变也恢复近似正常。结论 胆道梗阻时肝脏能耐受全肝血流阻断 (2 0min)所致的肝缺血再灌注损伤。

Objective To explore the effect of total hepatic vascular exclusion (THVE) on liver ischemia reperfusion injury in rabbits with cholestasis.Methods Thirty rabbits were divided into three groups:normal control (group A),cholestasis (group B) and THVE (group C). During liver ischemia reperfusion,hepatic tissue oxygon pressure (PtiO 2) was monitored. Serum total bilirubin (TBIL) and glutamic pyruvic transaminase (ALT) were also measured. The histopathologic changes of liver were observed under light microscope.Results In the groups B and C,hepatic PtiO 2 value was significantly decreased after THVE. 60 min after ischemia reperfusion,hepatic PtiO 2 value was not restored,significantly different from that before ischemia (P<0.05). At 60 min of reperfusion,the PtiO 2 values in the group B were restored much more slowly than in the group C (P<0.05). The ALT values before liver ischemia in the groups B and C were (265.0±13.8) U/L and (44.5±3.9) U/L,respectively. At different time points of 24 h during liver ischemia reperfusion,ALT values were further increased,more significant in the group B than in the group C. At 7th day,ALT values in the groups B and C returned to normal levels,and so did the pathologic changes of hepatic cell injury.Conclusion During cholestasis,live could safely tolerate THVE (20 min) induced hepatic ischemia reperfusion injury.