长时间门静脉阻断对肝脏肠道结构影响及门体侧枝分流观察

目的观察常温下长时间门静脉阻断再通后对肝脏、肠道的影响及与阻断时间的关系，明确有无门体侧枝开放及与门静脉阻断耐受性的关系。方法40只家兔随机均分成4组：A组（假手术组）、B组（单纯门静脉阻断30min）、C组（单纯门静脉组断60min）和D组（单纯门静脉阻断90min）。分别于阻断前、复流前行门静脉测压，比较各组间门静脉压力差值。于复流前行直接门静脉造影观察门体侧枝循环分流情况，6h后取肝脏，空、回肠组织观察组织形态学变化，取下腔静脉血测肝肾功能。结果B、C、D组肝脏、肠黏膜结构及肝功能与A组相比均有不同程度损伤，肾功能各组间无差异，门静脉阻断后胃肠道淤血可不同程度通过门体侧枝回流，门静脉压在60min内逐渐升高，60min后有下降趋势。结论常温下门静脉阻断再通后可导致肝脏、肠道功能结构损伤，且随时间延长而加重，门脉淤血可以不同程度通过门体侧枝回流，从而减轻肠道损伤。

Effect on the Structure and Function of Liver and Gut and Observation of Portal-Systemic Collateral after Long-time Portal Vein Blocking

Objective To investigate the effect of long-time portal vein blocking on liver and gut at normothermia temporarily and their correlations,determine whether portal vein blood can reflow into systemic circulation by portal-systemic collaterals.Methods Forty rabbits were allocated into four groups at random.The portal vein was clamped for 0 min(group A),30 min(group B),60 min(group C),and 90 min(group D) respectively in different group.The press of portal vein before clamping and refluxing were measured respectively,and direct photography was performed before portal vein blood back flow for observing porto-systemic collateral.After six hours,the vena cava blood were harvested for detecting liver and renal functions.Morphology changes of liver,jejunum,and ileum were also analyzed.Results The structure of liver and intestinal mucosa and the function of liver in portal vein clamping groups were diversely damaged in comparison of the sham group.But there were no statistically significant difference in renal function among four groups.Congestion of gut can flow into systemic circulation by porto-systemic collaterals .The press of portal vein increased gradually in 60min after portal vein clamping,but decreased in the group in which clamped portal vein more than 60min.Conclusion liver and intestinal mucosa damage occurred after temporary portal vein clamping at normothermia.Congestion of gut can flow into systemic circulation at different degree by porto-systemic collateral vessels.which can reduce the ischemia damage of gut.