CAJ | 학술논문

目的探索在正常及高胆红素血症情况下,大鼠70%肝切除联合肝固有动脉切除对肝功能、肝细胞能量代谢以及肝再生和细胞凋亡的影响.方法雄性成年SD大鼠133只,将其中40只分为2组,每组20只,均行胆总管-十二指肠插管桥接,同时行70%肝切除或70%肝切除联合肝固有动脉切除.另87只行胆总管结扎制备梗阻性黄疸模型.5 d后手术分为70%联合肝切除胆肠再通内引流组,及70%肝切除联合肝固有动脉切除、胆肠再通内引流2组.动态观察术后24 h、72 h、7 d肝功能和肝细胞能量代谢、肝组织HGF和bcl-2 mRNA含量及其蛋白表达、肝细胞增殖指数和凋亡指数的变化,并统计各组死亡率.另取6只作为假手术组,测定术后0 h肝功能和肝细胞能量指标.结果正常大鼠能够耐受70%肝切除联合肝动脉切除,术后肝细胞能量代谢和肝功能迅速恢复正常,肝再生良好.高胆红素血症时,大鼠术后肝再生受抑制,细胞凋亡增多.较之70%肝切除组,70%肝切除联合肝固有动脉切除组对肝细胞能量代谢的影响更为显著,术后肝功能恶化,肝组织HGF和Bcl-2 mRNA含量显著减少,肝再生明显受抑制,细胞凋亡增多,死亡率显著增高(P<0.05).结论正常大鼠70%肝切除联合肝动脉切除术后肝再生不受影响,高胆红素血症时,70%肝切除联合肝动脉切除的大鼠死亡率高,因此术前引流减黄应是必要的措施.
목적 탐색재정상급고담홍소혈증정황하,대서70%간절제연합간고유동맥절제대간공능、간세포능량대사이급간재생화세포조망적영향.방법 웅성성년SD대서133지,장기중40지분위2조,매조20지,균행담총관-십이지장삽관교접,동시행70%간절제혹70%간절제연합간고유동맥절제.령87지행담총관결찰제비경조성황달모형.5 d후수술분위70%연합간절제담장재통내인류조,급70%간절제연합간고유동맥절제、담장재통내인류2조.동태관찰술후24 h、72 h、7 d간공능화간세포능량대사、간조직HGF화bcl-2 mRNA함량급기단백표체、간세포증식지수화조망지수적변화,병통계각조사망솔.령취6지작위가수술조,측정술후0 h간공능화간세포능량지표.결과 정상대서능구내수70%간절제연합간동맥절제,술후간세포능량대사화간공능신속회복정상,간재생량호.고담홍소혈증시,대서술후간재생수억제,세포조망증다.교지70%간절제조,70%간절제연합간고유동맥절제조대간세포능량대사적영향경위현저,술후간공능악화,간조직HGF화Bcl-2 mRNA함량현저감소,간재생명현수억제,세포조망증다,사망솔현저증고(P<0.05).결론 정상대서70%간절제연합간동맥절제술후간재생불수영향,고담홍소혈증시,70%간절제연합간동맥절제적대서사망솔고,인차술전인류감황응시필요적조시.
Objective To study liver function, hepatic energy metabolism, regeneration and apoptosis in obstructive jaundiced or normal liver after 70% partial hepatectomy (PH) with hepatic artery resection (HAR) in rats. Methods In this study, 133 male SD rats were enrolled, 6 rats were in sham operation group, 20 rats underwent choledochoduodenostomy after 70% PH and 20 rats did 70%- PH, choledochoduodenostomy plus HAR. The remaining 87 rats 5 days after common bile duct ligation (CBDL) were randomized into two groups: 70% PH with choledochoduodenostomy, and 70% PH with choledochoduodenustomy plus HAR. Serum TB, ALT, ALB and ALP; tissue of hepatic HGF, bcl-2 mRNA and protein expression; ATP, ADP and AMP in hepatic tissues; hepatocyte proliferation/ apoptosis index were observed postoperatively (24 h, 72 h and 7 d). MortaLity was calculated. Results Rats without obstructive jaundice could tolerate 70% PH plus HAR with good liver regeneration. Compared with other groups, the serum liver function index; ATP content and EC value; HGF,bcl-2 mRNA content of liver tissue and the hepatocyte proliferation/apoptosis index in 70% PH with HAR group significantly aggravated and the mortality signiticanfly increased in obstructive jaundice rats ( P < 0. 05). Conclusions (1) The liver regeneration and apoptosis were not significantly influenced in normal mrs undergoing 70% PH and 70% PH with HAR, moreover hepatoeyte energy metabolism and liver function recovered rapidly in both groups. (2) With the existence of severe bilirubinemia, 70% PH with HAR caused an increased mortality suggesting a rationale for a preoperative bilirubin reducing procedures before a major surgery in malignant obstructive jaundice.