肠腔分流下巴马小型猪肝脏耐受入肝血流阻断的安全时限研究

目的 了解在肠腔分流条件下正常巴马小型猪肝脏耐受缺血的安全时限,为临床上阻断肝脏血流的时间及设计合理手术方案提供实验依据.方法 将18只正常小型猪随机分为A组(肝血流阻断90 min)、B组(肝血流阻断100 min),在肠腔分流的条件下,观察2组动物的术后存活情况、入肝血流阻断前后,再灌注0、1 h、1～5 d时肝功能及组织病理改变.结果 ①A组动物长期存活率显著高于B组(100%与44.4%, P＜0.05).②2组动物ALT在术后2、3 d显著升高,术后4 d时与术前无显著差异,术后2、3 d时B组显著高于A组;复流1 h时2组AST水平达峰值,此后逐渐下降,术后3 d与术前无显著性差异,复流1 h、术后1、2 d时B组AST显著高于A组;A组动物缺血时D-BIL、T-BIL显著升高,复流1 h后降至正常水平,B组动物至术后5 d才恢复正常水平,于复流前、复流1 h、术后1、2、3、4 d时B组动物D-BIL、T-BIL均显著高于A组.③2组动物缺血时肝组织损伤明显,复流1 h时损伤进一步加重,A组及B组长期存活动物肝组织结构于术后4 d恢复正常;与A组比较,B组肝组织损伤显著,坏死灶明显增多.结论 避免门静脉淤滞条件下正常巴马小型猪常温耐受入肝血流阻断的安全时限可达90 min.

On tolerance limit for normothermic hepatic inflow occlusion by meso-caval shunt in Bama swines

Objective To establish an animal model of hepatic inflow occlusion with meso-caval shunt in Bama swines so as to evaluate the tolerance limit of normothermic hepatic inflow occlusion.Methods Eighteen Bama swines were divided into group A in which the hepatic blood inflow was occluded for 90 min and group B in which the hepatic blood inflow was blocked for 100 min.The animal survival rate,the changes of liver function and histopathology were observed.Results The animal survival rate was significantly higher in group A than group B(100% vs 44.4%,P<0.05).Compared with the pre-ischemia value,ALT levels in the two groups on the 2 nd and 3 rd day postoperatively were significantly increased.On the 4 th day postoperatively ALT recovered to normal level.ALT level was significantly higher in group B than group A on the 2 nd and 3 rd days postoperatively.AST in the two groups peaked at 1 h after reperfusion,and recovered to normal on the 3 rd day postoperatively.AST was significantly higher in group B than group A at 1 h after reperfusion and on the 1 st and 2 nd days postoperatively.T-BIL and D-BIL levels in group A at ischemia 90 min were significantly higher than the pre-ischemia levels,and then decreased to the normal level.T-BIL,D-BIL levels in group B peaked after 100 min of ischemia,and returned to normal on the 5 th day postoperatively.T-BIL and D-BIL levels in group B were significantly higher than group A at the end of ischemia,1 h after reperfusion and postoperative days 1-4.Hepatic injury was severer at 1 h after reperfusion in both groups.The hepatic tissue recovered to normal in group A on the 4 th day postoperatively;however,hepatic necrosis was found in group B.Conclusion Ninety minutes is the tolerance limit for normothermic hepatic inflow occlusion in swine under conditions of meso-caval shunt.