保留半肝动脉血供的入肝血流阻断法对大鼠肝缺血再灌注损伤的影响

目的:探讨保留半肝动脉血供的入肝血流阻断法对大鼠肝血缺再灌注损伤的影响.方法:将96只Wistar大鼠随机分为Pringle法Ⅰ组、半肝阻断Ⅱ组和保留半肝动脉血供的入肝血流阻断Ⅲ组.阻断肝血流30 min后,去血管夹恢复血流,分别于再灌注后1,2,6,24 h,抽血检测ALT和AST水平,然后取肝组织用于检测肝脏超氧化物歧化酶(SOD)及丙二醛(MDA)含量、肝脏病理学及肝细胞凋亡.结果:与Ⅰ组比较Ⅱ组和Ⅲ组再灌注后各时间点,ALT,AST,肝组织MDA含量及细胞凋亡率显著降低,肝组织SOD活力明显升高.Ⅲ组肝功改变、肝组织MDA含量、SOD活力及肝细胞凋亡率与Ⅱ组之间无显著差异(P>0.05).结论:保留半肝动脉血供的入肝血流阻断法对肝脏缺血再灌注损伤轻,效果好,操作简单,因而优于半肝血流阻断法.     

保留半肝动脉血流阻断法在肝细胞癌手术中的意义

目的探讨保留半肝动脉血流阻断法在肝细胞癌(HCC)患者手术中的应用价值。方法回顾性分析2014年2月至2016年10月在我院接受治疗的HCC患者的临床资料,根据其手术方式分为Pringle法组和保留半肝动脉血流阻断法组,比较两组患者手术一般情况,比较两组患者手术前后肝功能、肿瘤标志物及并发症发生率。结果两组患者手术时间无差别,保留半肝动脉血流阻断法组术中出血量较Pringle法组少,住院时间较Pringle法组短;两组患者治疗前肝功能指标无差别,治疗后3个月,保留半肝动脉血流阻断法组的ALT、AST、DBil和TBil水平低于Pringle法组;两组患者治疗前肿瘤标志物水平无差别,治疗后3个月,保留半肝动脉血流阻断法组的CA19-9和AFP水平低于Pringle法组;两组患者胸腔积液、消化道再出血及感染发生率无明显差别。结论保留半肝动脉血流阻断法在HCC患者手术中效果较好,具有良好的应用价值。     

保留半肝动脉血供的肝血流阻断技术应用观察

肝切除术中常温下阻断入肝血流的安全时限是15～20min,尤其合并肝硬变的肝切除,时同更应控制在15m in之内,如超过这一时限可导致肝坏死、肝衰竭。为减少术中非切除肝组织的缺血损害,许多学者采用半肝血流阻断法,然而有些病例因种种原因无法实现半肝血流阻断。为解决这一矛盾,2002年8月至2005年3月,我院采用保留半肝动脉血供的肝血流阻断技术行肝切除术32例,效果良好。现报告如下。     

血红素氧合酶对大鼠肝脏缺血再灌注损伤细胞凋亡及相关基因的影响

目的通过应用血红素氧合酶（HO）的诱导剂氯高血红素和抑制剂锌原卟啉（ZnPP），探讨HO对大鼠肝脏缺血再灌注（IR）细胞凋亡及其相关基因的影响。方法将96只Sprague—Dawley大鼠采用钳夹法制备肝脏IR模型，随机分为假手术组、IR组、氯高血红素组和ZnPP组，检测再灌注0、1．5、4h和8h各个时间点大鼠肝脏功能以及病理学改变，流式细胞法测定肝细胞凋亡率、TUNEL法观察再灌注后4h大鼠肝细胞的凋亡情况，Western blot法检测再灌注后8h Bcl-2和Caspase-3的表达。结果在IR组各时间点均可见ALT和AST增高，病理学检查可见肝细胞肿胀，肝窦变窄，嗜中性粒细胞浸润和片状坏死等变化，肝组织中细胞凋亡率明显升高，Bcl-2的表达减少，而Caspase-3的表达增加。在氯高血红素组再灌注后1．5、4h和8h ALT和AST值明显降低，肝脏病理学改善，凋亡细胞减少及细胞凋亡率降低，肝脏Bcl-2的表达增加，Caspase-3的表达减少。ZnPP组则显示与之相反的结果。结论HO在肝脏IR损伤中具有保护作用，这种保护作用可能与抑制细胞凋亡有关。     

SHVE在规则性肝切除术中的应用

56例肝切除术患者分为半肝血流阻断术组（P组）、选择性阻断入肝和出肝血流（SHVE）组（S组）,比较两组手术时间和术中出血量,术后肝功能的恢复以及术后并发症。结果：P、S组手术时间无显著性差异（P〉0．05）,术中出血量分别为617ml、426n11（P〈0．05）,S组术后3d和6d的血清谷丙转氨酶（ALT）水平显著低于P组,白蛋白水平显著高于P组（P〈0．01）;P组术后并发症显著高于S组。认为SHVE可将病侧肝脏与体循环进行有效隔离,防止健侧肝脏缺血再灌注损伤,肝外控制肝静脉,不阻断下腔静脉,全身血流动力学稳定,是一种安全、有效的肝血流阻断技术。     

七氟烷对大鼠缺血再灌注损伤肝脏的保护作用及其机制

目的 观察七氟烷对大鼠缺血再灌注损伤肝脏的保护作用,并探讨其机制.方法 雌性SD大鼠32只,随机分为A、B、C、D4个组,各8只.A、B组采用腹腔注射1％戊巴比妥钠(PB) 40 mg/kg麻醉,A组仅分离肝脏周围韧带不阻断入肝血流;B组麻醉后夹闭肝动脉和门静脉左支,造成约70％肝脏缺血60 min、再灌注3h,建立肝脏缺血再灌注模型.C、D组采用七氟烷吸入麻醉,C组余操作同A组,D组麻醉后行部分肝脏缺血再灌注.采用化学发光法检测血清ALT、AST和乳酸脱氢酶(LDH);采用硫代巴比妥酸分光光度法方法检测肝组织内丙二醛(MDA)、超氧化物歧化酶(SOD)和谷胱甘肽(GSH);采用HE染色和Tunel染色进行组织学观察;Western blot法检测肝脏组织中的Caspase3、p53蛋白.结果 D组血清ALT、AST、LDH、MDA低于B组,SOD和GSH高于B组(P均＜0.05).D组缺血再灌注损伤肝脏组织形态学变化轻于B组,且肝脏组织中的Caspase3和p53蛋白表达水平亦较B组减少(P均＜0.05).B、D组肝细胞凋亡指数高于A、C组,且B组高于D组(P均＜0.05).结论 七氟烷对大鼠缺血再灌注损伤肝脏具有保护作用,可能是通过抑制肝细胞凋亡来实现的.     

肝动脉血流延迟开放对大鼠肝移植胆道I/R损伤的影响

目的 探讨肝动脉血流延迟开放对大鼠肝移植胆道缺血/再灌注(I/R)损伤的影响.方法 将大鼠随机分为双重血流同时开放组(P组)、门静脉先开放组(N组)和假手术对照组(S组),供肝再灌注后检测血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、转肽酶(GGT)、碱性磷酸酶(AKP)、总胆红素(TBIL)及直接胆红素(DBIL)水平,比色法测定髓过氧化物酶(MPO)含量,RT-PCR法检测胆管组织TNF-α及ICAM-1 mRNA表达.结果 肝脏再灌注后24 h,P组ALT、AST、GGT、AKP、TBIL、DBIL水平及胆管损伤病理学评分均明显低于N组(P均<0.05);再灌注后6 h,N组大鼠肝组织MPO含量明显高于P组(P<0.05);再灌注后2、6 h,P组大鼠肝组织TNF-α及ICAM-1 mRNA水平均明显低于N组(P均<0.05).结论 肝动脉血流延迟开放可以加重肝移植物胆管组织的I/R损伤.     

肝缺血再灌注损伤与细胞凋亡关系的临床研究

目的 通过检测肝缺血再灌注前后肝组织的细胞凋亡情况,探讨临床手术中肝缺血再灌注与细胞凋亡之间的关系,为更好地预防或减轻临床肝脏手术中造成的缺血再灌注损伤(HIRI)提供理论基础.方法 以细胞凋亡测定法(TUNEL 法)测定肝缺血再灌注前后肝细胞的凋亡情况.结果 肝门阻断前与肝门开放时和关腹前肝细胞的凋亡指数各组间的差异有统计学意义(P＜0.01),肝门阻断前肝细胞的凋亡指数高于肝门开放时和关腹前肝细胞的凋亡指数(P＜0.01);肝门开放时肝细胞的凋亡指数高于关腹前肝细胞的凋亡指数(P＜0.01).结论 研究表明肝脏手术中,在肝细胞短时间(15 min左右)缺血后的再灌注损伤中,肝细胞凋亡和缺血再灌注损伤呈负相关,它并不是术后早期肝细胞损伤的一种主要方式.     

半肝血流阻断法与肝门阻断法在肝切除术中的应用效果比较

目的探讨不同血流阻断方案在原发性肝细胞癌患者手术中的效果,为肝切除术中最佳血流阻断方式的选择提供参考。方法回顾性分析2010-06~2017-06肝细胞癌行开腹肝部分切除患者78例,按手术中肝血流阻断方式分为两组:A组(半肝血流阻断)40例,B组(Pringle法肝门阻断)38例。对两组患者手术时间、术中出血量、术中血流阻断时间、术后血清丙氨酸转氨酶水平、术后早期并发症情况进行比较。结果A组中位手术时间为160.5 min,中位失血量为498.2 ml,中位血流阻断时间为33.7 min,B组依次为155.3 min、512.0 ml和31.6 min,两组差异无统计学意义(P0.05)。A组术后第1天、第3天、第7天的丙氨酸转氨酶水平低于B组(P0.05)。A组发生术后并发症5例(12.5%),其中胆瘘1例,肝断面出血1例,胸腔积液2例,切口感染1例。B组发生术后并发症8例(21.1%),其中胆瘘2例,胸腔积液3例,大量腹水3例。两组术后早期并发症发生率比较差异有统计学意义(P0.05)。结论半肝血流阻断法较传统Pringle法肝门阻断法在原发性肝细胞癌患者手术中可以减轻术后肝功能损害,降低并发症发生率,是肝癌肝切除术中一种安全、有效的血流控制方法,值得临床推广应用。     

Pringle法与肝下下腔静脉阻断联合Pringle法在肝脏巨大血管瘤切除术中的应用效果评价

目的评价两种不同的入肝血流阻断方式在肝脏巨大肝血管瘤切除术中的应用效果。方法选取2008年1月-2014年12月于天门市中医医院住院的肝脏巨大血管瘤患者20例,将其分为A、B两组,每组10例。A组采用Pringle法进行肝血流阻断,B组采用肝下下腔静脉阻断联合Pringle法阻断入肝血流。比较两组患者的手术时间、肝门血流阻断时间、术中出血量、输血率以及术后肝功能指标。计量资料组间比较采用t检验,计数资料组间比较采用Fisher精确检验。结果两组患者手术时间、肝门血流阻段时间比较,差异均无统计学意义(P值均0.05);B组患者的术中出血量、输血量及输血率明显低于A组,差异均有统计学意义(P值均0.05);与A组相比,B组患者术后第3天及第7天的ALT、AST及TBil水平均较低,差异均有统计学意义(P值均0.05);两组术后并发症发生率差异均无统计学意义(P值均0.05)。结论肝下下腔静脉阻断联合Pringle法阻断入肝血流在巨大血管瘤切除术中不仅能够减少术中失血量,而且有利于患者术后肝功能的恢复,值得在临床上推广应用。     

Hepatic blood inflow occlusion without hemihepatic artery control in treatment of hepatocellular carcinoma

AIM:To investigate the clinical significance of hepatic blood inflow occlusion without hemihepatic artery control (BIOwHAC) in the treatment of hepatocellular carcinoma (HCC).METHODS:Fifty-nine patients with HCC were divided into 3 groups based on the technique used for achieving hepatic vascular occlusion:group 1,vascular occlusion was achieved by the Pringle maneuver (n=20);group 2,by hemihepatic vascular occlusion (HVO) (n=20);and group 3,by BIOwHAC (n=19).We compared the procedures among the three groups in term of operation time,intraoperative bleeding,postoperative liver function,postoperative complications,and length of hospital stay.RESULTS:There were no statistically significant differences (P > 0.05) in age,sex,pathological diagnosis,preoperative Child’s disease grade,hepatic function,and tumor size among the three groups.No intraoperative complications or deaths occurrred,and there were no significant intergroup differences (P > 0.05) in intraoperative bleeding,hepatic function change 3 and 7 d after operation,the incidence of complications,and length of hospital stay.BIOwHAC and Pringle maneuver required a significantly shorter operation time than HVO;the difference in the serum alanine aminotransferase or aspartate aminotransferase levels before and 1 d after operation was more significant in the BIOwHAC and HVO groups than in the Pringle maneuver group (P < 0.05).CONCLUSION:BIOwHAC is convenient and safe;this technique causes slight hepatic ischemia-reperfusion injury similar to HVO.     

肝断面血流阻断器在肝癌切除术中的应用

目的:比较不同的肝血流阻断方法在肝切除术中应用的有效性及安全性.方法:回顾性分析我院2004-2009年117例行肝切除术的肝癌患者的相关资料.A组:自制肝断面血流阻断器局部血流控制(n=42);B组:解剖性半肝血流阻断(n=35);C组:第一肝门阻断(Pringle法,n=40).比较3组患者术中出血量和手术时间、术后肝功能的恢复以及术后并发症的发生率.结果:术中出血量和手术时间A组均明显少于B(P=0.026,P<0.001)、C(P<0.001,P<0.001)组.A组术后第3、7天肝功能(TB、ALT)的明显好于C组(TB:P=0.014,=0.009;ALT:P<0.001,P<0.001).C组术后有29例出现不同程度的腹水,术后腹水发生率显著高于A组(P<0.001);2例发生肝功能衰竭,1例出现胃肠道出血,死亡1例.结论:肝切除术中采用肝断面血流阻断器能有效控制出血、缩短手术时间,对肝功能影响小,是一种简便、安全有效的方法.     

Hemihepatic versus total hepatic inflow occlusion during hepatectomy: a systematic review and meta-analysis

AIM:To evaluate the clinical outcomes of patients undergoing hepatectomy with hemihepatic vascular occlusion(HHO) compared with total hepatic inflow occlusion(THO).METHODS:Randomized controlled trials(RCTs) comparing hemihepatic vascular occlusion and total hepatic inflow occlusion were included by a systematic literature search.Two authors independently assessed the trials for inclusion and extracted the data.A metaanalysis was conducted to estimate blood loss,transfusion requirement,and liver injury based...     

参芎注射液对大鼠脑缺血再灌注后神经细胞凋亡的相关研究

目的探讨参芎注射液对大鼠脑缺血再灌注后神经细胞凋亡及凋亡相关因子caspase-8、抗凋亡因子FLIP的蛋白及其mRNA表达的影响。方法选择SD大鼠100只随机分为正常组(10只)、假手术组(10只)、模型组(40只)和参芎注射液治疗组(干预组,40只),采用TUNEL法检测神经细胞凋亡,免疫组织化学及RT-PCR法分别检测caspase-8、FLIP的蛋白和mRNA表达。结果与正常组和假手术组比较,模型组大鼠各时间点凋亡细胞明显增加(P<0.01),caspase-8、FLIP的蛋白和mRNA表达明显增强(P<0.05,P<0.01)。与同时间点模型组比较,干预组大鼠凋亡细胞明显减少,caspase-8蛋白和mRNA表达明显减弱(P<0.05,P<0.01),FLIP蛋白和mRNA表达分别于再灌注6 h和12 h时间点明显增强(P<0.05)。结论参芎注射液能通过减弱caspase-8表达及增强FLIP表达,从而拮抗大鼠脑缺血再灌注后神经细胞凋亡。     

Hyperamylasemia after hepatic resection

BACKGROUND/AIMS: Hyperamylasemia often occurs after hepatectomy, but the detailed mechanism of this phenomenon remains unclear. The aim of this study was to analyze factors that may be associated with the development of hyperamylasemia following hepatic resection. METHODOLOGY: The Pringle maneuver was performed in 12 patients (Pringle group), the hemihepatic vascular occlusion technique in 11 patients (Hemihepatic group). RESULTS: In the Pringle group, postoperative serum amylase levels were elevated significantly in comparison with the preoperative levels, but were not elevated in the hemihepatic group. CONCLUSIONS: It is suggested that portal congestion by portal triad interruption carries a potential risk of serum amylase elevation and pancreatitis after hepatectomy.     

Safe upper limit of intermittent hepatic inflow occlusion for liver resection in cirrhotic rats

AIM To evaluate the effects of varying ischemicdurations on cirrhotic liver and to determine the safeupper limit of repeated intermittent hepatic inflowocclusion.METHODS Hepatic ischemia in cirrhotic rats was inducedby clamping the common pedicle of left and median lobesafter non-ischemic lobes resection.The cirrhotic ratswere divided into six groups according to the duration andform of vascular clamping:sham occlusion(SO),intermittent occlusion for 10(IO-10),15(IO-15),20(IO-20)and 30(IO-30)minutes with 5 minutes of reflow andcontinuous occlusion for 60 minutes(CO-60).All animalsreceived a total duration of 60 minutes of hepatic inflowocclusion.Liver viability was investigated in relation ofhepatic adenylate energy charge(EC).Triphenyltetrazollum chloride(TTC)reduction activitieswere assayed to qualitatively evaluate the degree ofirreversible hepatocellular injury.The biochemical andmorphological changes were also assessed and a 7-daymortality was observed.RESULTS At 60 minutes after reperfusion following atotal of 60 minutes of hepatic inflow occlusion,EC valuesin IO-10(0.749±0.012)and IO-15(0.699±0.002)groupswere rapidly restored to that in SO group(0.748±0.016),TTC reduction activities remained in high levels(0.144±0.002mg/mg protein,0.139±0.003mg/mg protein and0.121±0.003mg/mg protein in SO,IO-10 and IO-15groups,respectively).But in IO-20 and IO-30 groups,EClevels were partly restored(0.457±0.023 and 0.534±0.027)accompanying with a significantly decreased TTCreduction activities(0.070±0.005mg/mg protein and0.061±0.003mg/mg protein).No recovery in EC values(0.228±0.004)and a progressive decrease in TTCreduction activities(0.033±0.002mg/mg protein)wereshown in CO-60 group.Although not significantlydifferent,the activities of the serum aspartateaminotransferase(AST)on the third postoperative day(POD_3)and POD_7 and of the serum alanineaminotransferase(ALT)on POD_3 in CO-60 group remained higher than that in intermittent occlusion groups.Moreover,a 60% animal mortality rate and more severemorphological alterations were also shown in CO-60group.CONCLUSION Hepatic inflow occlusion during 60 minutesfor liver resection in cirrhotic rats resulted in lesshepatocellular injury when occlusion was intermittentrather than continuous.Each period of 15 minutes was thesafe upper limit of repeated intermittent vascularocclusion that the cirrhotic liver could tolerate withoutundergoing irreversible hepatocellular injury.     

Continuous normothermic hemihepatic vascular inflow occlusion over 60 min for hepatectomy in patients with cirrhosis caused by hepatitis B virus

Aim: To evaluate the safety of remnant liver in cirrhotic patients who had undergone irregular hepatectomy with continuous normothermic hemihepatic vascular inflow occlusion for over 60 min. Methods: A group of 133 cirrhotic patients who had hepatitis B virus accompanied by hepatocellular carcinoma and had undergone irregular hepatectomy by hemihepatic vascular inflow occlusion was studied. According to the time of hemihepatic vascular inflow occlusion, patients were assigned either to the control group, treatment(60) group, or treatment(90) group. The quantity of blood loss and blood transfusion, routine liver biochemistry and postoperative complications were retrospectively analyzed. Results: The data showed that there were no significant differences in postoperative complications between the three groups. Compared to the preoperative day, the levels of aspartate transaminase (AST), alanine transaminase (ALT), prothrombin time (PT) and serum bilirubin on postoperative days 1 and 3 were significantly increased in all three groups and the levels of albumin and platelet were significantly decreased on postoperative day 1. Duration of hospital stay and the levels of ALT and AST on postoperative days 1, 3 and 7 were higher in the treatment(90) group than in the control group and treatment(60) group (P < 0.05). However, no significant differences were displayed in the length of hospital stay and the levels of AST, ALT, PT, albumin, platelet count and serum bilirubin on postoperative days 1, 3 and 7 between the control group and the treatment(60) group (P > 0.05). Conclusion: Hemihepatic vascular inflow occlusion over 60 min is a possible method for irregular hepatectomy in patients with cirrhosis caused by the hepatitis B virus. However, caution must be exercised in utilizing this method where the time of vascular occlusion is over 90 min.     

不同肝血流阻断方案对手术切除原发性大肝癌患者治疗效果比较

目的 探讨不同肝血流阻断方法对外科手术切除原发性大肝癌患者疗效的影响。方法 2014年5月~2016年5月收治的172例原发性大肝癌患者,分别采用肝门阻断（n=52）、半肝阻断（n=44）和联合阻断（n=76）血流行肝癌切除术。结果 三组患者的基本资料比较差异无统计学意义（P>0.05）;三组血流阻断时间、手术用时和切除肝量差异均无统计学意义（P>0.05）,肝门阻断组出血量为（736.38±498.36） ml,显著多于半肝阻断组[（472.56±111.89） ml或联合阻断组的（356.14±132.53） ml,P<0.05],肝门阻断组输血量为（586.54±132.58） ml,显著多于半肝阻断组[（427.95±210.47） ml或联合阻断组的（184.38±72.54） ml,P<0.05];术后7 d,肝门阻断组血清ALT水平为（73.02±43.41） U/L,显著高于半肝阻断组[（55.89±40.82） U/L或联合阻断组的（52.01±33.81） U/L,P<0.05];三组手术并发症以肺部感染、切口感染、胆瘘、腹腔积液为主,但其发生率差异无统计学意义（P>0.05）;联合阻断组1 a生存率为96.1%,肿瘤复发率为2.6%,显著低于肝门阻断组的75.0%和15.4%或半肝阻断组的68.2%和20.5%（P<0.05）。结论 Pringle法联合肝下腔静脉阻断术阻断血流在切除原发性大肝癌患者外科手术过程中可以有效降低术中出血量,促进患者术后恢复,或许还能提高生存率。     

外源性血管内皮生长因子对肝硬化大鼠肝组织血管的影响

目的:研究外源性血管内皮生长因子对肝硬化大鼠肝脏组织内血管的影响,以检测肝硬化大鼠肝脏微循环变化.方法:25只肝硬化门静脉高压造模成功SD♂大鼠,体质量180-220 g,随机分为肝硬化门静脉高压对照组(B组,n=10)和肝硬化门静脉高压实验组(C组,n=15),C组应用Alzet微渗泵从大鼠门静脉连续泵入血管内皮生长...     

Long-term protection of ischaemic myocardium by nitroglycerin ointment

To assess whether the reduction in ischaemic injury during acute myocardial infarction induced by nitroglycerin (NTG) results in a decrease in tissue necrosis, 96 rats were assigned to two groups. The first group (n = 34) was sham-operated. The second group of 62 rats was randomised in a ratio of 2:1 into control (n = 43) and treated (n = 19) subgroups following coronary artery occlusion. Treated animals received an application of 2% NTG ointment every 8 h immediately post-occlusion. All rats were killed 48 h after coronary artery occlusion and total creatine kinase activity (CK) of the left ventricle (LV) was measured. Infarct size calculated by CK depletion was 65.2 +/- 14.3% (mean +/- SD) of LV in control rats, and 51.6 +/- 14.0% of LV in NTG-treated (p less than 0.02). In a further series of 46 rats with coronary occlusion, the area of infarcted myocardium 21 days post-occlusion was assessed by planimetry on histological sections. In rats with control occlusion (n = 22), the extent of infarction was 30.6 +/- 4.8% of LV, and in NTG-treated rats (n = 24) it was 16.2 +/- 5.8% of LV (p less than 0.001). The amount of scar tissue in the infarcted myocardium 21 days post-occlusion was also determined by measuring LV hydroxyproline and collagen content in an additional 32 rats randomly assigned to a control (n = 11), a NTG-treated (n = 9) and a sham-operated group (n = 12).(ABSTRACT TRUNCATED AT 250 WORDS)