大鼠自体原位肝移植中逆行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行灌注与经门静脉顺行灌注法对急性肺损伤的影响。方法 Sprague-Dawley(SD)大鼠75只随机分成逆行灌注组、顺行灌注组、假手术组,建立大鼠自体原位肝移植逆行灌注、顺行灌注和假手术模型,各组于术后6h、12h、24h分别随机处死6只大鼠,测定肺干/湿重量比值、肺组织髓过氧化物酶(myeloperoxidase,MPO)活性、丙二醛(malondialdehyde,MDA)含量、肿瘤坏死因子(TNF)-α含量,行肺组织病理学检查。结果与假手术组比较,逆行灌注组和顺行灌注组术后肺干/湿重量比值变小,肺组织MPO活性、MDA含量、TNF-α含量增加,以术后6h与12h明显。与顺行灌注组比较,逆行灌注组术后6h、12h的肺干/湿重量比值较高,而肺组织MPO活性、MDA含量较低,差异有统计学意义(均为P<0.05);术后24h两组间在上述指标差异无统计学意义(均为P>0.05);逆行灌注组肺组织TNF-α含量在术后6h、12h、24h均显著降低,两组间差异有统计学意义(均为P<0.05)。肺组织苏木素-伊红染色:逆行灌注组、顺行灌注组均表现不同程度的肺泡结构破坏,肺泡间隔增厚,小静脉、毛细血管充血、淤血,炎症细胞浸润。其中术后6h、12h表现较重,术后24h较轻;同时显示逆行灌注组肺组织病理损伤较顺行灌注组明显减轻。结论大鼠自体原位肝移植术中用顺行灌注或逆行灌注,术后早期均存在急性肺损伤,其中术后6h和12h损伤较严重,术后24h肺损伤减轻;逆行灌注造成的急性肺损伤程度比顺行灌注要轻。

Impact of retrograde perfusion in autologous orthotopic liver transplantation on acute lung injury in rats

Objective To explore the impact of retrograde perfusion via inferior vena cava and antegrade perfusion via portal vein in autologous orthotopic liver transplantation on acute lung injury in rats. Methods Seventy-five Sprague-Dawley(SD) rats were randomly divided into three groups: retrograde perfusion group, antegrade perfusion group and sham operation group. After the models were established, six rats in each group were randomly executed at 6 h, 12 h and 24 h after operation,respectively. Dry-to-wet weight ratio of lung, the activity of myeloperoxidase(MPO), the content of malondialdehyde(MDA) and tumor necrosis factor(TNF)-α of lung tissue were measured. And the pathological section of lung was observed. Results Compared with sham operation group, dry-to-wet weight ratio of lung was lower in retrograde perfusion group and antegrade perfusion group, while the activity of MPO, the content of MDA and TNF-α were higher in the two groups. They were highest especially at 6 h and 12 h after operation. Compared with antegrade perfusion group, dry-to-wet weight ratio of lung was higher in retrograde perfusion group at 6 h and 12 h after operation, however, the activity of MPO and content of MDA in lung tissue were lower, in which there were significant difference(all in P<0.05). There was no significant difference between two groups at 24 h after operation(all in P>0.05). The content of TNF-α in retrograde perfusion group was lower at 6, 12 and 24 h after operation, and there was significant difference between two groups (all in P<0.05). The result of hematoxylin-eosin(HE) staining of lung issue showed different levels of performances in retrograde perfusion group and antegrade perfusion group, including destruction of alveolar structure, thickening of alveolar interval, congestion of small vein and capillary, and infiltration ofinflammatory cells. The performance at 6 h and 12 h was more severe than that at 24 h after operation. And the pathological damage of lung tissue in retrograde perfusion group was obviously milder than that in antegrade perfusion group. Conclusions Acute lung injury occurs in the early period both retrograde perfusion or antegrade perfusion in autologous orthotopic liver transplantation in rats, and the damage is more serious at 6 h and 12 h and alleviated at 24 h after operation. The level of acute lung injury in retrograde perfusion is lower than that in antegrade perfusion.