CAJ | 학술논문

目的观察不同断流术式对肝硬化门静脉高压症犬术后食管下段血管再生的影响.方法将肝硬化门静脉高压症模型犬48条,随机分为A组(传统断流组)、B组(选择性断流组)、C组(吻合器断流组)及D组(对照组),每组12条,术后随机分为A1、B1、C1、D1和A2、B2、C2、D2组,分别于术后1、6个月处死取食管下段分段切片,其中C组取材时注意分清吻合口的上、下方,分别记为Ca、Cb.用免疫组织化学方法检测所取组织中血管特异性因子血管内皮生长因子(VEGF)、CD34及Ⅷ因子相关抗原(FⅧ-Rag)的表达.结果术后1个月A1、B1、C1组食管下段各层VEGF的表达及CD34 MVD、FⅧ-Rag MVD明显低于D1组(P<0.05),B1组各指标明显低于A1组及C1b组,但明显高于C1a组(P均<0.05),C1a组各指标明显低于C1b组(P<0.05).术后6个月A2、B2组各指标分别较A1、B1组明显增高(P<0.05),C2a组仅外膜层各指标明显高于C1a组(P<0.05),而C2b组各层各指标明显高于C1b组(P<0.05).结论 3种不同断流术式术后1个月食管下段血管特异因子表达均下降,说明各断流术式近期可使食管下段血管减少,其中以吻合器断流术效果最为明显.术后6个月,传统断流术及选择性断流术食管下段血管特异因子表达升高,而经腹吻合器门奇断流术吻合口上方黏膜下层和同有层食管下段血管特异因子表达无明显变化,表明后者术后吻合口上方食管下段血管再生明显低于其他断流术式.
목적 관찰불동단류술식대간경화문정맥고압증견술후식관하단혈관재생적영향.방법 장간경화문정맥고압증모형견48조,수궤분위A조(전통단류조)、B조(선택성단류조)、C조(문합기단류조)급D조(대조조),매조12조,술후수궤분위A1、B1、C1、D1화A2、B2、C2、D2조,분별우술후1、6개월처사취식관하단분단절편,기중C조취재시주의분청문합구적상、하방,분별기위Ca、Cb.용면역조직화학방법검측소취조직중혈관특이성인자혈관내피생장인자(VEGF)、CD34급Ⅷ인자상관항원(FⅧ-Rag)적표체.결과 술후1개월A1、B1、C1조식관하단각층VEGF적표체급CD34 MVD、FⅧ-Rag MVD명현저우D1조(P<0.05),B1조각지표명현저우A1조급C1b조,단명현고우C1a조(P균<0.05),C1a조각지표명현저우C1b조(P<0.05).술후6개월A2、B2조각지표분별교A1、B1조명현증고(P<0.05),C2a조부외막층각지표명현고우C1a조(P<0.05),이C2b조각층각지표명현고우C1b조(P<0.05).결론 3충불동단류술식술후1개월식관하단혈관특이인자표체균하강,설명각단류술식근기가사식관하단혈관감소,기중이문합기단류술효과최위명현.술후6개월,전통단류술급선택성단류술식관하단혈관특이인자표체승고,이경복문합기문기단류술문합구상방점막하층화동유층식관하단혈관특이인자표체무명현변화,표명후자술후문합구상방식관하단혈관재생명현저우기타단류술식.
Objective To explore the effect on blood vessel regeneration of distal esophagus in ca-nines of portal hypertension with liver cirrhosis after different procedures with paraesophagastrie devascular-ization. Methods Portal hypertension models were produced in canines by subcutaneous injection of 60% CC14 combined with food restriction. Forty eight model canines were randomly divided into 4 groups: group A, traditional paraesophagastrie devascularization;group B, selective paraesophagastric devascularization;group C, paraesophagastric devascularization plus distal esophageal transaction and reanastomosis with sta-pler;group D,control group. Every group had 12 canines which were randomly divided into A1 ,B1 ,C1 ,D1, A2,B2,C2 and D2 groups after the operation. Canines in groups A1 ,B1 ,C1 and D1 were executed at first month after the operation,and those in groups A2, B2, C2 and D2 were executed at the 6th month after the operation. The distal esophagus was segmented when the canines were executed. The upside and downside of the stoma in group C were distinguished and signed as Ca and Cb. Immunohistochemieal methods were used to detect VEGF,CD34 and FVⅧ-Rag,blood vessel-related factors,in lower esophagus. Results The expres-sion levels of VEGF and CD34 MVD,FⅧ-Rag MVD in groups A1 ,B1 and C1 were lower than those in group D1 one month after the operation (P <0.05). All the indices in group B1 were lower than those in groups A1 and Clb,but higher than those in group Cla (P <0.05). The indices in group Cla were lower than those in group C1b (P < 0.05 ). The indices in groups A2 and B2 were higher than those in groups A1 and B1, re-spectively at the 6th month after the operation (P <0.05). They were higer in outer membrane in group C1a than in group C2a (P <0.05). The indices in group C2b were higher than those in group Clb (P<0.05). Conclusion At the first month after operation, the expression of blood vessel-related factors was declined in three different procedures of paraesophagastric devascularization,which indicated that all three different pro-cedures could diminish the vessels in distal esophagus. The effect in group C was most obvious among all groups. At the 6th month after traditional paraesophagastrie devascularization and selective paraesophagastrie devascularization, the expression of blood vessel-related factors in distal esophagus was declined. But there were no significant changes in the expression of blood vessel-related factors in distal esophagus after parae-sophagastric devascularization plus distal esophageal transaction and reanastomosis with stapler. It indicated that the blood vessel regeneration in paraesophagastric devascularization pins distal esophageal transaction and reanastomosis with stapler was inferior to that in other procedures.