中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (5): 807-810.doi: 10.3969/j.issn.1673-8225.2010.05.012

• 肝移植 liver transplantation • 上一篇    下一篇

常温肝内胆管缺血时间的安全时限：极限值在哪？

郑建忠1，梅敏杰2，段永亮3   

  1. 1 新疆医科大学第二附属医院普外科，新疆维吾尔自治区乌鲁木齐市 830028；2沈阳市苏家屯中心医院普外科，辽宁省沈阳市 110101；  3新疆维吾尔自治区中医院普外科，新疆维吾尔自治区乌鲁木齐市 830000
  • 出版日期:2010-01-29 发布日期:2010-01-29
  • 作者简介:郑建忠★，男，1975年生，新疆维吾尔自治区乌鲁木齐市，汉族，新疆医科大学二附院在读硕士，主要从事普外科，肝胆外科研究。 wensnow880@sohu.com

Security time limit of intrahepatic bile duct ischemia under common temperature: What is limiting value?

Zheng Jian-zhong1, Mei Min-jie2, Duan Yong-liang3   

  1. 1 Department of General Surgery, Second Affiliated Hospital, Xinjiang Medical University, Urumqi  830028, Xinjiang Uyghur Autonomous Region, China; 2 Department of General Surgery, Sujiatun Central Hospital, Shenyang   110101, Liaoning Province, China; 3 Department of General Surgery, Tradition Chinese Medical Hospital of Xinjiang Uyghur Autonomous Region, Urumqi  830000, Xinjiang Uyghur Autonomous Region, China
  • Online:2010-01-29 Published:2010-01-29
  • About author:Zheng Jian-zhong★, Studying for master’s degree, Department of General Surgery, Second Affiliated Hospital, Xinjiang Medical University, Urumqi 830028, Xinjiang Uyghur Autonomous Region, China wensnow880@sohu.com

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摘要：

背景：胆道缺血再灌注损伤是肝移植、肝切除和肝动脉栓塞化疗后胆管损伤的主要原因之一。但是，常温下肝脏究竟能够耐受多长时间的肝内胆管缺血目前尚无定论。
目的：利用兔胆道缺血再灌注损伤模型，分析兔肝内胆管缺血的安全时限。
方法：将家兔以抽签法随机分为假手术组、肝动脉和胆总管联合阻断1.5，2，2.5，3 h 组。假手术组只游离胆总管、肝总动脉及门静脉，肝动脉和胆总管联合阻断1.5，2，2.5，3 h 组用无损伤动脉夹平左、右肝管开口上缘夹闭肝动脉和胆总管及疏松结缔组织，阻断1.5，2，2.5，3 h后去除动脉夹即恢复肝动脉或胆道血流。术后1周统计动物存活情况，并进行肝功能检测。
结果与结论：假手术组及肝动脉和胆总管联合阻断1.5 h组动物术后1周无死亡，阻断2 h存活率为87.5%，随着阻断胆道血流时间的延长，动物生存率逐渐下降，提示动物耐受胆道血流阻断的最大安全时限为2 h。胆道缺血 2 h 以内肝脏病理组织学变化相对较轻，以细胞水肿和炎细胞浸润为主，坏死灶呈点状或小片状，以可逆性损伤为主；而缺血 2 h 以上胆管上皮坏死脱落明显，肝坏死呈多灶性、大片状，损伤不可逆。组织学变化同样证实2 h可能是常温下兔耐受肝内胆管血流阻断的最大安全时限。

关键词: 肝内胆管缺血, 安全时限, 胆总管, 肝动脉, 存活率, 肝移植

Abstract:

BACKGROUND: Biliary ischemia-reperfusion injury is one of the main reasons for the injury bile duct following liver transplantation, liver resection and hepatic artery thrombosis after chemotherapy. However, nothing has been decided yet concerning liver can tolerate long intrahepatic bile ducts ischemia under normal temperature.
OBJECTIVE: To use the rabbit biliary ischemia-reperfusion injury model, analyze the rabbit intrahepatic bile ducts ischemia security time.
METHODS: Rabbits were randomly divided into sham operation, hepatic artery and common bile duct joint blocking 1.5, 2, 2.5,  3 h groups. Sham operation group only free common bile duct, hepatic artery and portal vein. Hepatic artery and common bile duct joint blocking 1.5, 2, 2.5, 3 h groups, left and right hepatic duct openings superior margin was clamped using artery clamps, and hepatic artery, common bile duct and loose connective tissue were occluded. Following 1.5, 2, 2.5 and 3 hours, artery clamps were removed to recover hepatic artery or biliary tract blood flow. After a week, animal survival was calculated and liver function was tested.
RESULTS AND CONCLUSION: None animals in the sham operation and hepatic artery and common bile duct joint blocking 1.5 hour groups died; survival rate was 87.5% following 2 hours of blocking. Animal survival rate was decreased gradually with prolonged blocking time of blood flow. These indicated that the maximum safety time of blocking biliary duct blood flow was 2 hours. Pathological and histological changes were mild within 2 hours of blocking, mainly presenting cell edema and inflammatory cell infiltration, and necrotic focus was punctiform or fragmentis, reversible. While ischemia above 2 hours, bile duct epithelial necrotic shape was significant. The obvious, hepatic necrosis was multifocal, flake, irreversible damage. Histological change also confirmed that 2 hours may be maximum security limitation of rabbit tolerance intrahepatic bile duct flow blocking under normal temperature.

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