门静脉高压症贲门周围血管离断与结扎效果的比较

Effect Comparisons of Disconnection and Ligation of Peripheral Gastro-Esophageal Blood Vascular on Portal Hypertention Rates

目的 比较断流门静脉高压症贲门周围血管时离断与结扎两种方法的效果。方法 将 48只SD肝硬变门静脉高压症模型大鼠随机均分为离断组、结扎组及假手术组 3组 ,另选 6只SD大鼠作正常对照组 (仅行剖腹探查 )。前 3组动物分别于术后 3 0d及 10 0d各处死 8只 ,正常对照组于术后 3 0d全部处死 ,观察贲门及胃底与周围组织粘连及新生侧支血管情况和食管下段粘膜下层及固有层的相对平均血管数及静脉口径。结果 术后贲门胃底与周围组织粘连及新建侧支血管以离断组为著 ,结扎组较轻。食管下段粘膜下层及固有层的相对平均血管数和相对平均静脉口径 ,假手术组不同时相均显著高于正常对照组 (P<0 .0 5 ) ;术后 3 0d ,离断组及结扎组均显著低于假手术组 (P<0 .0 5 ) ;术后 10 0d ,两指标水平都有所回升 ,离断组已接近假手术组水平 (P>0 .0 5 ) ,但结扎组仍低于假手术组 (P<0 .0 5 )。结论 结扎法与离断法在对贲门周围血管进行断流时具有等同的近期效果 ,结扎法手术创面少 ,创伤小 ,术后粘连轻 ,新生血管较少形成 ,其断流的远期效果可能相对持久。

Objective This experiment is to compare the effect of two operations 'disconnection' and 'ligation' of separation of gastro esophageal peripharal blood vessel in portal hypertension and provide base of rational for selecting reasonable method of separation of gastro esophageal peripheral blood vessel in portal hypertension.Methods Forty eight SD rats were induced to model of liver cirrhosis and portal hypertension by CCL 4 . They were divided at random into 3 groups (16 rats each): disconnection group, ligation group and pseudo operation group. There was also a normal comparison group with 6 normal SD rats (laparotomy only). Thirty days and 100 days after the operation, 8 rats were killed respectively in every group except for the normal comparison group. Thirty days after the operation, the rats of normal comparison group were killed. The adhesion around gastric cardia and fundus with the building of new branch blood vessels, and the relative average blood vessel amounts and average vein caliber changes in submucosa layer and lamina propria layer of esophagus inferior segment were observed. Results In the observation of adhesion around gastro esophageal and the building of new branch blood vessels after the operations, disconnection group was more marked than ligation group. In the observation of relative average blood vessel amounts and average vein calibers changes in submucosa layer and lamina propria layer of esophagus inferior segment, pseudo operation group was more marked than in normal comparison group in different time( P <0.05),and 30 days after the operations, disconnection and ligation groups were less serious than pseudo operation group( P <0.05). One hundred days after the operation, the two observation indexes of all the groups were more serious than before, and result of disconnection group was nearly close to pseudo operation group( P >0.05), but ligation group was still less serious than pseudo operation group( P <0.05).Conclusion Both the 'disconnection' and 'ligation' operation have the same rank effect of separation of gastro esophageal peripharal blood vessel in short time. But the 'ligation' operation makes less trauma, postoperative adhesion and vascularizition, then the separation effect of the 'ligation' operation may sustain a relatively long time.