体外肝脏切除术对肝脏功能和结构的影响

方法:正常家猪13头，在体外静脉转流和4℃EuroCollins液持续灌注肝脏下行体外肝切除及自体残肝原位再植术。在手术中不同时相点检测肝组织能荷水平（EC）、线粒体呼吸活性（RCR）、动脉血酮体比值（AKBR）和肝脏病理变化。结果：在肝脏冷灌注时相，两组动物肝组织ATP、EC及AKBR水平较术前显著降低，RCR轻度降低。残肝植入后，术程平稳的6头动物，EC水平回升、RCR无显著变化、AKBR回升到0．7以上；术程不平稳的7头动物，RCR下降、EC进一步降低、AKBR仍低于0．5。冷灌注时肝脏组织结构基本保持完整，残肝再植复流后肝组织出现以肝腺泡第Ⅲ带为著的组织损害。结论：体外肝切除术造成肝脏损害的主要原因是再灌流损害；肝细胞能量代谢状态与手术动物的预后密切相关。

THE EFFECT OF EXTRACORPOREAL LIVER RESECTION ON THE FUNCTION AND STRUCTURE OF THE LIVER

In this study, 13 pigs were underwent EHR and divided into two groups: the uneventful group (n=6), in which the physiologic condition of the operated animals were severely interfered during the EHR;and the eventful group(n = 7),in which the physiologic parameters maintained stable during the procedure. The energy status of the liver was evaluated at several phase of the operation by measuring mitochondrial respiratory control ratio (RCR), energy charge level (EC)and arterial ketone body ratio (AKBR). The tissue levels of ATP and EC decreased significantly,and RCR decreasd mildly during the liver hypothermic perfusion as compared with those at the begining of the EHR in animal of both group.After the remnant liver autotransplantation,the level of hepatic EC and AKBR recovered,the RCR maintained unchange in the eventful-group;Whereas all of the three parameters decreased in the uneventful -group. The results of this study suggested that:the energy status of the remnant liver determined the outcome of the operation;the hepatic damage in the EHR is mainly caused by the reperfusion injury.