保留肝动脉血流间断门静脉阻断在肝切除术中的实验研究

摘要

目的 探索新型的肝切除术中血流阻断方法.方法 采用经尾状叶转流门静脉血流模型,根据阻断方式不同随机将大鼠分成3组,每组30只:对照手术组(SO)、间断完全肝门阻断组(IC)和保留肝动脉血流间断门静脉阻断组(HIC),设定阻断时间为90 min.阻断完成后切除肝左叶及尾叶,比较各组肝断面出血量,术后第0、1、3、7天共4个时相点血清谷丙转氨酶(ALP)活性、肝组织三磷酸腺苷(ATP)水平、肝组织丙二醛(MDA)水平及肝组织病理学改变情况.结果 SO组肝断面出血量[(302.6±10.2)mL]明显高于HIC组[(37.2±5.3)mL]和IC组[(35.8±4.5)mL];IC组术后1、3 d ALT[(5455.0±424.6)U/L、(2356.2±325.6)U/L]明显高于HIC组[(3230.0±332.5)U/L、(1653.5±176.7)U/L];术后IC组MDA[(7.15±1.22)nmol/mg]较HIC组[(4.16±0.89)nmol/mg]升高明显;术后HIC组ATP[(1.51±0.44)μmol/mg]明显高于IC组[(0.85±0.21)μmol/mg];以上差异均有统计学意义(P<0.05).病理形态观察,HIC组较IC组能明显减轻肝窦充血、肝细胞水肿,术后恢复快.结论 与间断Pringle法相比,保留肝动脉血流间断门静脉阻断方法不会明显增加术中肝断面的失血量,但可以明显减轻肝脏缺血再灌注损伤,是值得在临床应用的一种入肝血流控制方法.%Objective To explore a new method of blood flow blocking in hepatectomy. Methods The model of hepatic inflow occlusion with caudate lobe blood bypass was used in this experiment. According to the different way of blocking, rats were randomly divided into 3 groups (each group n=30): sham operation group (SO group), intermittent hepatic inflow occlusion group (IC group) and hepatic blood inflow intermittent occlu-sion without hepatic artery control group (HIC group). After completing resection of the left hepatic lobe and the caudate lobe, the liver ischemia-reperfusion injury within blocking time of 90 min were investigated by assessing liver blood loss, alanine aminotransferase (ALT), adenosine triphosphate (ATP), malondialdehyde (MDA) and morphology changes in rat liver 0, 1, 3 and 7 d postoperative. Results The amount of liver blood loss during hepatectomy in SO group [(302.6±10.2) mL] was much higher than those in HIC group [(37.2±5.3) mL] and IC group [(35.8±4.5) mL]. At 1 d and 3 d postreperfusion, the ALT levels in IC group [(5455.0±424.6) U/L, (2356.2±325.6) U/L] were significantly higher than those in HIC group [(3230.0±332.5) U/L, (1653.5±176.7) U/L]. At 0 d postreperfusion, the MDA level in IC group [(7.15±1.22) nmoL/mg] was much higher than that in HIC group [(4.16±0.89) nmoL/mg], but ATP level in HIC group [(1.51±0.44) μmoL/mg] was much higher than that in IC group [(0.85±0.21) μmoL/mg] (P<0.05). The postoperative hepatic injury in HIC group was lower and recover more quickly than that in IC group. Conclusion Compared with intermitent hepatic inflow occlusion method, he-patic blood inflow intermittent occlusion without hepatic artery control may not significantly increase blood loss in hepatectomy, but which can reduce the liver ischemia-reperfusion injury. This new method is worth of clinical application in the hepatic blood inflow occlusion.