大鼠自体原位肝移植术中肝外胆道不同部位对缺血再灌注损伤耐受性的比较

目的:观察大鼠移植肝的肝外胆道不同部位对缺血再灌注损伤的耐受性,为肝移植术中胆管吻合部位的选择奠定基础。方法:30只SD大鼠随机分为3组:Ⅰ组(假手术组,n=6)、Ⅱ组(胆道缺血1 h再灌注1 h组,n=12)、Ⅲ组(胆道缺血1 h再灌注2 h组,n=12)。对肝门部胆管、胆总管近端及远端的上皮细胞行凋亡(TUNEL法)检测、病理形态学评分和超微结构的定量分析,比较肝外胆道不同部位对缺血再灌注损伤的耐受性。结果:Ⅱ组肝移植大鼠肝门部胆总管上皮细胞凋亡率、病理形态学评分明显高于胆总管近端和胆总管远端(P<0.05),后二者间无统计学差异,提示肝门部损伤较重。肝门部线粒体平均体积(V)高于胆总管远端、近端,胆总管远端高于近端(P<0.05);肝门部微绒毛面积密度(AMV)低于胆总管远端、近端,胆总管远端低于近端(P<0.05),提示肝门部损伤最重,胆总管近端最轻。Ⅲ组肝移植大鼠肝外胆道肝门部损伤最重,胆总管远端次之,胆总管近端最轻(P<0.05)。结论:大鼠肝移植术中肝外胆道不同部位对缺血再灌注损伤的耐受性存在差异,其中胆总管近端耐受性最好,其可能是肝移植术中胆管吻合的合适部位。

Comparison of tolerance to ischemia-reperfusion injuries between different parts of extrahepatic bile duct during orthotopic autologous liver transplantation in rats

Objective:To observe the tolerance to ischemia-reperfusion injuries in different parts of extrahepatic bile duct during orthotopic autologous liver transplantation in rats,so as to lay a foundation for selection of anastomosis site during liver transplantation. Methods : Thirty SD rats were randomly divided into 3 groups:group I ,sham operated(n = 6) ; group Ⅱ , 1 h ischemia in biliary tract followed by 1 h reperfusion (n = 12); and group Ⅲ , 1 h ischemia in biliary tract followed by 2 h reperfusion(n = 12). TUNEL assay, pathomorphology score and ultrastructural quantitative analysis were used to analyze the epithelia of hilar bile duct,proximal, and distal common bile duct. Results:The results of TUNEL assay and pathomorphology score were not significantly different between the proximal and distal common bile ducts in group Ⅱ (P>0. 05) ,but the injury was more serious in hilar bile duct compared with those of the proximal and distal common bile ducts (P<005); the hilar bile duct had the most serious injuries as indicated by the changes of mitochondrial mean volume (V) and area density of microvilli (A_(mv)) ,and the proximal common bile duct had the slightest injury (P<0. 05). In group Ⅲ ,the most severe injury was found in the hilar bile duct,followed by distal common bile duct and proximal common bile duct in order (P<0. 05). Conclusion:The tolerance to ischemia-reperfusion is different in different parts of bile duct during liver transplantation, with the distal common duct having the best tolerance,which may be used for bile anastomosis during transplantation.