逆行隔离灌注化疗可减轻对大鼠肝脏的毒性及药物的泄漏

Objective The retrograde isolated hepatic perfusion (RIHP) model was used to compare with the isolated hepatic perfusion (IHP) model in reducing the rate of normal hepatic tissue toxicity and peripheral drug leakage during chemotherapy in rat liver. Methods A total of 90 male Sprague-Dawley rats weighing 300-350 g were randomized into 3 groups with 30 rats in each. Group A: perfusion with Lactated Ringer'S Solution through arteria hepatica (RA) and portal vein (PV),the inferior vena cava was used as an outflow tract of perfusate. Group B: For isolated hepatic perfusion (IHP), Fluorouracil (5-FU) was added into the perfusate at a dose of 350mg/kg and introduced in to the liver through arteria hepatica, portal vein was perfused by Lactated Ringer'S Solution, and the inferior vena cava was used as an outflow tract of perfusate. Group C: by using retrograde isolated hepatic perfusion (RIHP), the solution which contains 350 mg/kg Fluorouracil (5-FU) was also introduced through arteria hepatica, the inferior vena cava was introduced with Lactated Ringer'S Solution;the portal vein was used as an outflow tract of the perfusate. On day 1, 3, 5 and 7 after the perfusion in all groups, blood serum ALT test and liver histopathology test were performed. The peripheral blood drug levels were measured with high performance liquid chromatographic(HPLC) system in group B and group C. Results The survival rate was 90%, 86.7% and 90% in group A, B and C,respectively. No statistically significant difference was observed in the survival rate among the 3groups. In all the three groups, serum ALT levels were the highest on the first day after IHP: (481.6±207.6)μmol/LingroupA;(1641. 6±658.0) μmol/LingroupBand( 913. 0±353. 5)μmol/Lin group C. Significant higher serum ALT levels were observed by comparing group B and C with A(P＜0. 05). Meanwhile, the serum ALT levels were significantly higher in group B than in group C (P＜0.05). The peaks of peripheral blood drug concentration during the perfusion were 131.2±29.4μg/ml in group B and 65.3±28. 4μg/ml in group C. Significant difference was observed (P＜0. 05). Liver biopsies of group A showed mild changes on the first day after IHP and returned to normal after 7 days. Group B showed severe changes on the first day after IHP and local necrosis still existed after 7 days. Group C showed moderate changes as compared with group B on the first day after IHP and also returned to normal after 7 days. Conclusion Retrograde isolated hepatic perfusion (RIHP) can reduce the liver toxicity compared to isolated hepatic perfusion (IHP). Hopefully, RIHP will be considered as a safer way in regional chemotherapy in liver cancer.     

逆行隔离灌注化疗可减轻对大鼠肝脏的毒性及药物的泄漏

Objective The retrograde isolated hepatic perfusion (RIHP) model was used to compare with the isolated hepatic perfusion (IHP) model in reducing the rate of normal hepatic tissue toxicity and peripheral drug leakage during chemotherapy in rat liver. Methods A total of 90 male Sprague-Dawley rats weighing 300-350 g were randomized into 3 groups with 30 rats in each. Group A: perfusion with Lactated Ringer'S Solution through arteria hepatica (RA) and portal vein (PV),the inferior vena cava was used as an outflow tract of perfusate. Group B: For isolated hepatic perfusion (IHP), Fluorouracil (5-FU) was added into the perfusate at a dose of 350mg/kg and introduced in to the liver through arteria hepatica, portal vein was perfused by Lactated Ringer'S Solution, and the inferior vena cava was used as an outflow tract of perfusate. Group C: by using retrograde isolated hepatic perfusion (RIHP), the solution which contains 350 mg/kg Fluorouracil (5-FU) was also introduced through arteria hepatica, the inferior vena cava was introduced with Lactated Ringer'S Solution;the portal vein was used as an outflow tract of the perfusate. On day 1, 3, 5 and 7 after the perfusion in all groups, blood serum ALT test and liver histopathology test were performed. The peripheral blood drug levels were measured with high performance liquid chromatographic(HPLC) system in group B and group C. Results The survival rate was 90%, 86.7% and 90% in group A, B and C,respectively. No statistically significant difference was observed in the survival rate among the 3groups. In all the three groups, serum ALT levels were the highest on the first day after IHP: (481.6±207.6)μmol/LingroupA;(1641. 6±658.0) μmol/LingroupBand( 913. 0±353. 5)μmol/Lin group C. Significant higher serum ALT levels were observed by comparing group B and C with A(P＜0. 05). Meanwhile, the serum ALT levels were significantly higher in group B than in group C (P＜0.05). The peaks of peripheral blood drug concentration during the perfusion were 131.2±29.4μg/ml in group B and 65.3±28. 4μg/ml in group C. Significant difference was observed (P＜0. 05). Liver biopsies of group A showed mild changes on the first day after IHP and returned to normal after 7 days. Group B showed severe changes on the first day after IHP and local necrosis still existed after 7 days. Group C showed moderate changes as compared with group B on the first day after IHP and also returned to normal after 7 days. Conclusion Retrograde isolated hepatic perfusion (RIHP) can reduce the liver toxicity compared to isolated hepatic perfusion (IHP). Hopefully, RIHP will be considered as a safer way in regional chemotherapy in liver cancer.     

Clinical observation of tempofilter Ⅱ inferior vena cava filter in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis

Objective The aim of this study was to evaluate our experience with the retrievable Tempofilter Ⅱ inferior vena cava (IVC ) filter with regard to insertion, efficiency, ease of retrieval, and any associated complications. Methods A retrospective review was performed of 112 patients (44 female,64 male,mean age 52. 3 years) who underwent Tempofilter Ⅱ IVC filter insertion. Filter insertion was successful in all patients. The filter was placed in via the jugular vein of 112 cases with acute deep vein thrombosis (DVT) and (or) PE;after drug treatment, it was observed whether there existed PE symptoms and if the change of the filter location occurred and associated complications. Results All the inferior vena cana filters were successfully emplaced,and DVT responded well to the filters;no clinical relevant pulmonary embolism occurred;The mean dwell time of successfully retrieved filters was 19. 3 days ( range 8-69 days). The thrombus was trapped in 54 cases (48. 2% ). One vena cana filter was escaped. Conclusion Tempofilter Ⅱ vena cana filter is of exact curative effect in the p revention of PE and high value of clinical application.     

Clinical observation of tempofilter Ⅱ inferior vena cava filter in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis

Objective The aim of this study was to evaluate our experience with the retrievable Tempofilter Ⅱ inferior vena cava (IVC ) filter with regard to insertion, efficiency, ease of retrieval, and any associated complications. Methods A retrospective review was performed of 112 patients (44 female,64 male,mean age 52. 3 years) who underwent Tempofilter Ⅱ IVC filter insertion. Filter insertion was successful in all patients. The filter was placed in via the jugular vein of 112 cases with acute deep vein thrombosis (DVT) and (or) PE;after drug treatment, it was observed whether there existed PE symptoms and if the change of the filter location occurred and associated complications. Results All the inferior vena cana filters were successfully emplaced,and DVT responded well to the filters;no clinical relevant pulmonary embolism occurred;The mean dwell time of successfully retrieved filters was 19. 3 days ( range 8-69 days). The thrombus was trapped in 54 cases (48. 2% ). One vena cana filter was escaped. Conclusion Tempofilter Ⅱ vena cana filter is of exact curative effect in the p revention of PE and high value of clinical application.     

肾癌合并下腔静脉癌栓的多学科联合治疗

目的 探讨肾癌合并下腔静脉癌栓多学科联合治疗的临床意义.方法 经B超和CT检查诊断为右肾癌合并下腔静脉癌栓的患者2例,下腔静脉癌栓Ⅱ级和Ⅳ级各1例.全麻下取腹部人字形切口.泌尿外科行右肾切除;肝胆外科游离腔静脉至第二肝门,于癌栓上下阻断腔静脉和周围分支静脉;血管外科切开腔静脉完整取出癌栓,缝合腔静脉.例2患者腔静脉癌栓距右心房2-3cm,肿瘤侵及腔静脉血管壁及血管内膜,术中建立左股静脉-右心房转流,心肺转流241 min,阻断主动脉18 min,行自体血液回输、腔静脉置换及第二肝门肝静脉-人工血管吻合.分析手术适应证、手术时间、术中出血量、术后住院时间等.结果 2例均成功行根治性右肾切除术,完整取出癌栓.2例分别于术后15、27 d出院.分别随访1、16个月,未发现肿瘤局部复发及远处转移.结论 对于没有淋巴结侵犯和远处转移的肾癌合并下腔静脉癌栓患者,应积极行根治性肾切除术及癌栓取出术,多学科联合协作可缩短手术时间、降低手术风险、减少肿瘤复发、提高患者生存率.

Abstract：

Objective To evaluate the surgical treatment for renal cell carcinoma with inferior vena cava tumor thrombus and the clinical significance of multidisciplinary treatment. Methods Two cases of renal cell carcinoma with inferior vena cava thrombus diagnosed by Doppler ultrasonography and CT were included in this retrospective analysis. The tumor thrombus was in level Ⅱ in one case and in level Ⅳ in the other. Coagulation test and complete blood count were done again before surgery. Human albumin, fibrinogen, prothrombin complex, plasma, platelet, UW and irrigating solution were prepared before the operation.Under general anesthesia, surgery was performed using abdomen inverted Y shaped incision. Right radical nephrectomy was finished by the urological surgeon; the vena cava was completely dissected from the renal vein level to the secondary porta of the liver by the hepatobiliary surgeon, the vena cava and the surrounding branch vein were blocked in the upper and lower vena cava tumor thrombus; tumor thrombus was removed completely by the vascular surgeon. In one case (patient with level Ⅳ thrombus ) where the tumour thrombus invaded the wall of the vena cava, the thrombus was found to be extending to the cavo-atrial junction but not into the right atrium. The left femoral venous-right atrial bypass was established, the cardiopulmonary bypass lasted for 241 mia, and the aorta was blocked for 18 min. Salvage autotransfusion was used during surgery, and the hepatic vein of the secondary liver porta was anastomosed to artificial vascular graft.The data for surgical indication, operation time, operative blood loss and postoperative hospital stay were analyzed. Results Right radical nephrectomy and inferior vena cava thrombectomy were performed successfully, and the two patients were discharged on the 15th and 27th day after surgery, respectively. The two patients were followed up for 1 and 16 months after surgery, respectively, and both survived without local recurrence and distant metastasis. Conclusion Radical nephrectomy and inferior vena cava thrombectomy is the preferred method for patients without metastasis, and multidisciplinary cooperation could shorten the operation time, reduce the tumor recurrence and increase the survival rate of patients.     

化疗对CD133+结肠癌细胞的作用效果

目的 观察化疗前后结肠癌细胞株HT29、SW620中CD133+结肠癌细胞的数量变化,探讨化疗对CD133+结肠癌细胞的作用效果.方法 取对数生长的结肠癌细胞株HT29、SW620,采用80 mg/L 5-氟尿嘧啶(5-Fu)和25 mg/L奥沙利铂(Oxaliplatin)分别作用8 h,并设对照组,利用CD133抗体进行标记后再用流式细胞仪进行检测,观察化疗前后CD133+细胞的比例.结果 流式细胞仪检测结肠癌细胞株HT29,80 mg/L 5-Fu处理8 h组中CD133+肿瘤细胞为45.00%,与未处理组(32.80%)比较结果差异有统计学意义(P＜0.01);25 mg/L奥沙利铂处理8 h组中CD133+肿瘤细胞为55.30%,与未处理组和80 mg/L 5-Fu处理8 h组比较结果差异有统计学意义(P＜0.01).流式细胞仪检测结肠癌细胞株SW620,80 mg/L 5-Fu处理8 h组中CD133+肿瘤细胞为47.10%,与未处理组(33.90%)比较结果差异有统计学意义(P＜0.01);25 mg/L奥沙利铂处理8 h组中CD133+肿瘤细胞为56.50%,与未处理组和80 mg/L 5-Fu处理8 h组比较结果差异有统计学意义(P＜0.01).结论 CD133+结肠癌细胞能明显抵抗化疗.

Abstract：

Objective To observe the changes of quantity of CD133 + cells in HT29 and SW620 cell lines before and after chemotherapy, and detect the effect of chemotherapy on CD133 + cells. Methods HT29 and SW620 cells in logarithmic growth phase were separately treated with 80 mg/L 5-fluorouracil(5-Fu) and 25 mg/L oxaliplatin for 8 h, and analyzed by flow cytometry after being marked by CD133 antibody. The proportion of CD133 + cells before and after chemotherapy was measured. Results For HT29 cells, the proportion of CD133 + cancer cells in the group treated with 80 mg/L 5-Fu for 8 h was 45.00% with the difference being remarkable ( P ＜ 0. 01 ) compared to the non-treatment group ( 32. 80% ). The proportion of CD133 + cancer cells in the group treated with 25 mg/L oxaliplatin for 8 h was 55.30% with the difference being remarkable ( P ＜ 0. 01 ) compared with both the non-treatment group and the group treated with 80 mg/L 5-Fu for 8 h. For SW620 cells, the proportion of CD133 + cancer cells in the group treated with 80 mg/L 5-Fu for 8 h was 47. 10% with the difference being remarkable ( P ＜0. 01 ) compared with the non-treatment group (33.90%). The proportion of CD133 + cancer cells in the group treated with 25 mg/L oxaliplatin for 8 h was 56. 50% with the difference being remarkable ( P ＜ 0. 01 ) compared with both the non-treatment group and the group treated with 80 mg/L 5-Fu for 8 h. Conclusion CD133 positive colon cancer cells have anti-chemotherapy activity obviously.     

山东半岛成人肾下下腔静脉直径与长度测量及其意义

Objective To measure the diameter and length of infrarenal inferior vena cava (IVC)in Shandong Peninsula adult through digital subtraction angiography ( DSA) for better vena cava filter (VCF) choice and placement. Methods From April 2008 to June 2010, 83 discontinuous patients (49 males and 34 females, mean age 56. 4 years) with deep venous thrombosis ( DVT) of lower extremity were placed VCF through DSA according to ACCP-8. During operation, diameter and length of infrarenal IVC were measured. At the same time, the renal vein location and the type of the IVC were identified to help the VCF choice. Results All the VCFs were placed successfully, no complications occurred. The diameter of infrarenal IVC was 10 to 26 mm with a mean of (19 ±5) mm. The average length from beginning of IVC to the lower renal vein was (10. 6 ±2. 8) cm. The renal vein was located between the first and second lumbar vertebra, the IVC beginning was located between the fourth and fifth lumbar vertebra. Conclusions Diameter and length measurement of infrarenal IVC is helpful to the VCF selection and the domestic VCF research. Vena cava angiography is very important to the accurate placement of VCF.     

山东半岛成人肾下下腔静脉直径与长度测量及其意义

Objective To measure the diameter and length of infrarenal inferior vena cava (IVC)in Shandong Peninsula adult through digital subtraction angiography ( DSA) for better vena cava filter (VCF) choice and placement. Methods From April 2008 to June 2010, 83 discontinuous patients (49 males and 34 females, mean age 56. 4 years) with deep venous thrombosis ( DVT) of lower extremity were placed VCF through DSA according to ACCP-8. During operation, diameter and length of infrarenal IVC were measured. At the same time, the renal vein location and the type of the IVC were identified to help the VCF choice. Results All the VCFs were placed successfully, no complications occurred. The diameter of infrarenal IVC was 10 to 26 mm with a mean of (19 ±5) mm. The average length from beginning of IVC to the lower renal vein was (10. 6 ±2. 8) cm. The renal vein was located between the first and second lumbar vertebra, the IVC beginning was located between the fourth and fifth lumbar vertebra. Conclusions Diameter and length measurement of infrarenal IVC is helpful to the VCF selection and the domestic VCF research. Vena cava angiography is very important to the accurate placement of VCF.     

山东半岛成人肾下下腔静脉直径与长度测量及其意义

Objective To measure the diameter and length of infrarenal inferior vena cava (IVC)in Shandong Peninsula adult through digital subtraction angiography ( DSA) for better vena cava filter (VCF) choice and placement. Methods From April 2008 to June 2010, 83 discontinuous patients (49 males and 34 females, mean age 56. 4 years) with deep venous thrombosis ( DVT) of lower extremity were placed VCF through DSA according to ACCP-8. During operation, diameter and length of infrarenal IVC were measured. At the same time, the renal vein location and the type of the IVC were identified to help the VCF choice. Results All the VCFs were placed successfully, no complications occurred. The diameter of infrarenal IVC was 10 to 26 mm with a mean of (19 ±5) mm. The average length from beginning of IVC to the lower renal vein was (10. 6 ±2. 8) cm. The renal vein was located between the first and second lumbar vertebra, the IVC beginning was located between the fourth and fifth lumbar vertebra. Conclusions Diameter and length measurement of infrarenal IVC is helpful to the VCF selection and the domestic VCF research. Vena cava angiography is very important to the accurate placement of VCF.     

他克莫司胶囊和缓释胶囊预防肝移植急性排斥反应的效果和安全性

Objective To evaluate the efficacy and safety of tacrolimus exposure in stable liver transplant recipients converted from FK506 twice a day to Advagraf (tacrolimus extended-release capsules) once daily. Methods This was an open-label, random, control and multi-center study.Eligible patients were 19 to 70 years of age, 6 months post-transplant with stable renal and hepatic function and receiving stable doses of tacrolimus twice a day for 2 weeks prior to enrollment. There were 86 patients in the experimental group and the control group, separately. The average age of experimental group and control group was 46 ± 10 and 49 ± 9, respectively. Patients in experimental group received Advagraf, once daily, and the dose was adjusted according to the drug concentration,and the drug concentration was between 2 to 10 μg/L. The control group given tacrolimus, twice daily, and the drug concentration was between 2 to 10 μg/L. Results The incidence of acute rejection reaction was 1.20 % and 1.18 % respectively in experimental group and control group, and the 95 %confidence interval was -3.25% ～3.31 % and -3.26% ～ 3.34 %, individually. There was 1 case of acute rejection reaction in experimental group and control group, respectively. The patient and organ survival rate was 100%. Sixteen adverse events occurred in 15 patients (17.65 %) of the experimental group, and 10 adverse events occurred in 10 patients (11.63 %) of control group. Severe adverse events relating to the test drug in experimental group occurred in 4 patients (4. 71 %). and 2 patients (2. 33) in control group.Conclision Clinical trials indicated that Advagraf has efficacy and safety profiles similar to those of tacrolimus. The drug is safe and may improve patient compliance.     

自体原位肝移植逆行灌注法对大鼠急性肾损伤的影响

目的探讨自体原位肝移植术中经下腔静脉逆行灌注对大鼠肾功能的影响,为临床肝移植应用经下腔静脉逆行灌注法提供实验依据。方法 60只自体原位肝移植大鼠随机分为逆行灌注组、门静脉灌注组与假手术组各20只。前两组建立自体肝移植模型,其中逆行灌注组采用经下腔静脉逆行灌注法,先开放下腔静脉,再开放门静脉,最后开放肝动脉。门静脉灌注组采用常规经门静脉正向灌注法,先开放门静脉,再开放下腔静脉,最后开放肝动脉。假手术组开腹后游离肝门处门静脉、肝动脉及肝上、下下腔静脉,不予阻断,17min后关腹。分别检测3组术前1h、术后1h、8h及术后1d、5d的血清肌酐(Scr)、血尿素氮(BUN)水平;无肝期结束后1h、8h、1d取左肾组织行光镜检查观察肾组织病理形态学变化。结果术前1h,各组肾功能指标比较差异均无统计学意义(均为P>0.05);与假手术组比较,逆行灌注组、门静脉灌注组术后1h、8h及1d的Scr、BUN水平显著增高,而且逆行灌注组上述两指标明显低于门静脉灌注组(均为P<0.05),但术后5d3组比较差异均无统计学意义(均为P>0.05)。无肝期结束后1h,逆行灌注组和门静脉灌注组肾组织病理学检查发现肾间质充血,8h出现明显的肾小管上皮细胞水肿及肾间质充血,逆行灌注组明显轻于门静脉灌注组;无肝期结束后1d两组肾组织损伤呈现好转趋势,且逆行灌注组明显优于门静脉灌注组。结论自体原位肝移植术中实施逆行灌注可减轻大鼠急性肾损伤,改善大鼠早期肾功能。     

布-加综合征大鼠动物模型的建立

目的探索采用下腔静脉缩窄术建立布-加综合征大鼠动物模型的可行性。方法将50只SD大鼠采用完全随机法随机分为实验组和假手术组,全麻开腹,分离肝上下腔静脉。实验组借鉴缩窄门静脉主干法,丝线环绕结扎肝后下腔静脉,使下腔静脉横截面积缩窄约80%。2组分别于术后不同时间点（第1、4、8、12周）行腹部彩超、肝功能、血常规及肝脏病理学检查。结果实验组在第4周时均出现肝后下腔静脉及主肝静脉梗阻,淤血性肝硬变,腹水,肝脾肿大,门静脉扩张,肝实质内交通支开放,而假手术组正常。模型建立后第4周时,实验组大鼠肝功能中ALB及血常规中WBC、PLT、RBC、HGB较假手术组明显降低（P〈0.05）,ALT、AST、AKP、TBIL、DBIL、TBA较假手术组明显升高（P〈0.05）。结论下腔静脉缩窄术可成功建立布-加综合征大鼠动物模型。     

逆行隔离灌注化疗可减轻对大鼠肝脏的毒性及药物的泄漏

目的 采用大鼠肝脏隔离灌注模型探讨逆行隔离灌注(RIHP)较顺行隔离灌注(IHP)能否减少正常肝组织损伤及化疗药物外周泄漏率.方法 将90只体重300～350 g雄性SD大鼠随机分为A、B、C三组,每组30只:A组为空白对照组,经肝动脉及门静脉灌注乳酸林格液,以下腔静脉为灌注液流出道;B组行IHP,经肝动脉灌注含有350 mg/kg的氟尿嘧啶(5-Fu),门静脉灌注乳酸林格液,以下腔静脉为灌注液流出道;C组行RIHP,经肝动脉灌注含有350 mg/kg的氟尿嘧啶(5-Fu),经下腔静脉灌注乳酸林格液,以门静脉为灌注液流出道.术后1、3、5、7 d分别行血清ALT测定及肝组织病理学检查;高效液相色谱分析仪检测B、C组术中外周血药浓度.结果 三组术后3 d存活率分别为90.0%、86.7%和90.0%,三者差异无统计学意义.三组血清ALT均在术后第一天达到峰值,A组为(481.6±207.6)μmol/L;B组为(1641.6±658.0)μmol/L;C组为(913.0±353.5)μmol/L.B、C组均显著高于A组(P＜0.05);B组显著高于C组(P＜0.05).B组与C组术中外周血药浓度峰值分别为(131.2±29.4)μg/ml和(65.3±28.4)μg/ml.两组外周浓度有显著性差异(P＜0.05).A组术后肝脏病理改变较轻,术后7 d基本恢复正常;B组术后肝脏病理学改变相对严重,术后7 d局部仍可见坏死灶;C组术后肝脏病理改变后较A组严重,但较B组轻,术后7 d基本恢复正常.结论 RIHP较之IHP能够显著减轻化疗药物对正常肝组织的毒副作用和药物的外周泄漏,有望成为一种对肝癌更加有效安全的区域化疗方法.     

The measurement of hepatic circulation before and after orthotopic liver transplantation in dog--by using transit-time blood flow meter and H2 clearance method

Orthotopic liver transplantation was successfully carried out in 40 mongrel dogs, in which hepatic circulation was investigated before and after grafting. Blood flows in hepatic artery, portal vein and intrahepatic inferior vena cava were measured by using transit-time ultrasonic blood flow meter and regional tissue blood flow was determined by hydrogen gas clearance method. Before transplantation the mean blood flows were 234 +/- 95mg/min in portal vein, 118 +/- 76ml/min in hepatic artery and 291 +/- 103ml/min in inferior vena cava in 40 recipients. The blood flow ratio of portal vein and hepatic artery was 2.9 +/- 2.2. The mean regional blood flow of the liver was 63 +/- 24ml/min/100g. After transplantation, the mean blood flows decreased to 189 +/- 86ml/min in portal vein, 77 +/- 51ml/min in hepatic artery and 179 +/- 111ml/min in inferior vena cava and the regional tissue blood flow was 57 +/- 25ml/min/100g. Hepatic arterial flow decreased by 37 percent after transplantation, however, portal venous flow decreased by 24 percent and the regional blood flow decreased by 9 percent after transplantation of the liver. These data suggested that the microcirculation of the liver was slightly disturbed after liver transplantation in dog, which was in part due to the decreased blood flows of the hepatic artery and portal vein.     

门腔静脉转位术对大鼠肝细胞凋亡及PCNA表达的影响

目的：观察大鼠行门腔静脉转位术（PCT）后的肝功能及肝组织学变化。方法：将72只雄性SD大鼠随机均分为实验组和对照组，实验组大鼠行PCT（门静脉近端与下腔静脉远端进行端-端吻合，门静脉远端与肝下下腔静脉近端进行端-端吻合），对照组大鼠行门静脉和下腔静脉血流阻断，时间与实验组对应者无肝期一致。两组分别于术后6，12，24 h和3，7，28 d各取6只大鼠，行血清谷丙转氨酸（ALT）和谷草转氨酸（AST）检测，肝组织病理学检查及凋亡检测，同时检测肝组织核增殖抗原（PCNA）的表达。结果：术后24 h内实验组大鼠血清ALT，AST水平明显高于对照组（均P<0.05），但呈逐渐降低趋势，在3，7，28 d各时间点两组大鼠血清ALT，AST水平均无统计学差异（均P>0.05）；病理学观察显示，对照组肝组织形态基本正常，而实验组呈轻微病理学改变，表现为细胞水肿、点状坏死和少量炎性细胞浸润，以术后6 h最为明显；两组在各时间点均可见少量肝细胞凋亡，但凋亡指数（AI）均无统计学差异（均P>0.05）；实验组肝组织PCNA表达在术后24 h及3，7 d时明显高于对照组（均P<0.05），但28 d后下降，与对照组无统计学差异（P>0.05）。结论：PCT后近期对肝脏造成一定的损害，但长期可能不会对肝细胞增殖和凋亡造成明显的影响。     

Can Coronary Vein Size Predict Hemodynamic Instability During Inferior Vena Cava Clamping in Liver Transplantation?

Objective

This study aimed to determine whether coronary vein size can serve as a predictor of hemodynamic instability during inferior vena cava clamping in living-donor liver transplantations.

Methods

Fifty-two patients' hemodynamic data before and after clamping were retrospectively analyzed and compared with the use of linear regression and repeated measurement. Data included arterial blood pressure, heart rate, central venous pressure, cardiac output, cardiac index, stroke volume, stroke volume variation, and systemic vascular resistance.

Results

The values of hemodynamic parameters at 1, 3, 10, and 30 minutes after clamping were compared with baseline data. All changes were found to be significant when the presence of the coronary vein was not considered. When the coronary vein was taken into consideration, linear regression analysis showed that only the percentage changes of cardiac index; stroke volume at 1, 3, and 10 minutes; and systemic vascular resistance at 1 minute after portal and inferior vena cava clamping were significantly correlated with the presence of the coronary vein.

Conclusions

Coronary vein size is a weak predictor of hemodynamic tolerability and instability during portal vein and inferior vena cava clamping in this kind of surgery.     

大鼠自体原位肝移植逆灌注法对急性肺损伤的影响

目的探讨大鼠自体原位肝移植术中经下腔静脉逆灌注与经门静脉顺灌注法对急性肺损伤的影响。方法SD大鼠24只随机分成逆灌注组、顺灌注组、假手术组,分别建立大鼠自体原位肝移植逆灌注、顺灌注和假手术模型,检测3组术后6h腹主动脉血气、肺髓过氧化物酶活性、肺干湿重比值及肺组织病理形态学变化。结果与假手术组比较,逆灌注组、顺灌注组的动脉血pH值、PaO2、肺干湿重比值明显降低,肺髓过氧化物酶活性显著增高,差异均有统计学意义（P〈0．05）。与顺灌注组比较,逆灌注组动脉血pH值、PaO2、肺干湿重比值升高,肺髓过氧化物酶活性降低,差异有统计学意义（P〈0．05）。逆灌注组、顺灌注组术后肺组织均存在急性损伤病理表现,逆灌注组损伤程度有所减轻。结论大鼠自体原位肝移植逆灌注法、顺灌注法后均存在急性肺损伤,逆灌注法较顺灌注法损伤程度要轻。     

Could the use of interposition grafts for arterial reconstruction be avoided by more caudate graft placement in living donor liver transplantation?

One of the major challenges in living donor liver transplantation (LDLT) is short and small vessels (particularly the hepatic artery), particularly in segmental liver grafts from living donors. In the present study we report an alternative surgical technique that avoids interpositional vessel grafts or tension on the connection by anastomizing the allograft hepatic vein to the recipient inferior vena cava in a more caudate location. From March 2000 to January 2003, 28 patients (11 women/17 men) underwent 28 LDLT. Until June 2001, the preferred technique for hepatic vein anastomosis was end-to-end anastomosis between the allograft hepatic vein and the recipient hepatic vein (HV-HV) (n = 10). Thereafter an end-to-side anastomosis was performed between allograft hepatic vein and recipient inferior vena cava (HV-IVC) (n = 18). The level of venotomy on the recipient vena cava was decided according to the pre-anastomotic placement of the allograft in the recipient hepatectomy site with sufficient width to have an hepatic artery anastomosis without tension or need for an interposition graft during hepatic artery and portal vein anastomoses. Except the right lobe allograft with anterior and posterior portal branches, all portal and hepatic artery anastomoses were constructed without an interposition graft or tension in the HV-IVC group. Only one hepatic artery thrombosis developed in the HV-IVC group. As a result, this technique may avoid both hepatic artery thrombosis and the use of interposition grafts in living donor liver transplantation.     

Hemodynamic changes with initiation of veno-venous bypass in orthotopic liver transplant patients

Removal of the liver to start the anhepatic stage of liver transplantation requires cross-clamping of the portal vein, inferior vena cava, and hepatic artery. Adverse effects occur from engorged splanchnic beds and decreased venous return. A veno-venous bypass from the inferior vena cava and portal vein to the axillary vein is used in an attempt to ameliorate these changes. The purpose of this study was to evaluate the effect of institution of veno-venous bypass on hemodynamics. Eight randomly selected adult patients undergoing orthotopic liver transplantation had general anesthesia induced with thiamylal and maintained with nitrous oxide and isoflurane. Cardiopulmonary data and arterial and mixed venous blood gases were measured prospectively using radial artery and pulmonary artery catheters. Measurements were taken under four conditions: (1) 10 minutes before bypass; (2) after partial bypass (vena cava to the axillary vein); (3) after partial bypass with portal vein clamping; and (4) after full bypass (vena cava and portal vein to the axillary vein). Statistically significant changes seen were a 22% decrease in cardiac output and a 47% increase in systemic vascular resistance (SVR). Bypass flow was lower than predicted. Venovenous bypass ameliorates, but does not fully prevent, the reduction of cardiac output and rise in SVR seen with initiation of the anhepatic stage. However, bypass does prevent the hypotension experienced during cross-clamping and for these reasons should be used routinely.     

Tumor Necrosis Factor-α, Interleukin-1β and Nitric Oxide: Induction of Liver Megamitochondria in Prehepatic Portal Hypertensive Rats

Abstact It has been shown that portal hypertension in the rat causes microvesicular hepatocytic fatty infiltration. Formation of megamitochondria (MG) is one of the most prominent alterations in steatosis. Because nitric oxide (NO), tumor necrosis factor-α (TNFα), and interleukin-1β (IL-1β) impair mitochondrial function, these mediators have been studied in prehepatic portal hypertensive rats to verify their coexistence with MG and therefore with steatosis. Male Wistar rats were divided into two groups: a control group (n = 7) and a group with partial portal vein hgation (n = 19) at 6 weeks of evolution. TNFα and IL-1β were quantified in liver by enzyme-linked immunosorbent assay, and NO was measured in the portal vein, suprahepatic inferior vena cava, and infrahepatic inferior vena cava by the Griess reaction. In portal hypertensive rats, the-serum concentration of NO of hepatic origin increases (132.10 ± 34.72 vs. 52.44 ± 11.32 nmol/ml; p < 0.001), as do TNF-α (2.02 ± 0.20 vs. 1.12 ± 0.43 μmol/mg protein) and IL-1β (18.95 ± 2.59 vs. 5.48 ± 1.70 μmol/mg protein) (p = 0.005) in the liver. The most frequent hepatic histologic findings are the presence of MG (p < 0.001), steatosis, and hyperplasia. An increase in hepatic release of NO, TNFα and IL-Iβ with MG formation is produced in rats with portal hypertension. Therefore these proinflammatory mediators and this morphologic mitochondrial alteration could both be involved in the etiopathogenesis of steatosis.