中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2011年
9期
732-735
,共4页
王亮%李宇%牛兆建%周岩冰
王亮%李宇%牛兆建%週巖冰
왕량%리우%우조건%주암빙
高血压,门静脉%微循环%动物模型%外科手术
高血壓,門靜脈%微循環%動物模型%外科手術
고혈압,문정맥%미순배%동물모형%외과수술
Hypertensin, portal vein%Microcirculation%Animal models%Surgical procedures,operative
目的 观察胃去门静脉循环断流术（de-splanchnic circulation of the stomach，DSCS）对肝前型门静脉高压犬胃黏膜及黏膜下微循环血管超微结构的影响。方法 将12只成年杂种犬按照“李宗芳法”（门静脉缩窄一半，丝线引起门静脉慢性血栓形成）制作犬肝前型门静脉高压食管静脉曲张模型，并于建模后4周造影检查侧支循环及曲张静脉形成情况。成模后随机分为两组，分别行贲门周围血管离断术和DSCS手术，于开腹后、手术后即刻及术后4周末测定食管曲张静脉压力，手术前、手术后4周末测定肝功能指标。术后4周末取胃组织进行透射电镜观察。结果 DSCS手术组食管曲张静脉压力由术前的(22.1±0.9) cm H2O降至术后4周的(17.8±0.4) cm H2O，差异有统计学意义(P＜0.01)。手术前后肝功能指标变化不明显(P＞0.05)。超微结构显示贲门周围血管离断术组胃黏膜上皮细胞微绒毛断裂、脱落，微绒毛明显减少，黏膜下微静脉内皮细胞基膜厚薄不均且不连续，内皮细胞间隙可见明显红细胞聚集；而DSCS组胃黏膜上皮细胞微绒毛排列较整齐，断裂少见，黏膜下微静脉内皮细胞未见明显异常。结论 DSCS手术可降低肝前型门静脉高压犬食管曲张静脉压力，改善胃黏膜及黏膜下微循环血管超微结构。
目的 觀察胃去門靜脈循環斷流術（de-splanchnic circulation of the stomach，DSCS）對肝前型門靜脈高壓犬胃黏膜及黏膜下微循環血管超微結構的影響。方法 將12隻成年雜種犬按照“李宗芳法”（門靜脈縮窄一半，絲線引起門靜脈慢性血栓形成）製作犬肝前型門靜脈高壓食管靜脈麯張模型，併于建模後4週造影檢查側支循環及麯張靜脈形成情況。成模後隨機分為兩組，分彆行賁門週圍血管離斷術和DSCS手術，于開腹後、手術後即刻及術後4週末測定食管麯張靜脈壓力，手術前、手術後4週末測定肝功能指標。術後4週末取胃組織進行透射電鏡觀察。結果 DSCS手術組食管麯張靜脈壓力由術前的(22.1±0.9) cm H2O降至術後4週的(17.8±0.4) cm H2O，差異有統計學意義(P＜0.01)。手術前後肝功能指標變化不明顯(P＞0.05)。超微結構顯示賁門週圍血管離斷術組胃黏膜上皮細胞微絨毛斷裂、脫落，微絨毛明顯減少，黏膜下微靜脈內皮細胞基膜厚薄不均且不連續，內皮細胞間隙可見明顯紅細胞聚集；而DSCS組胃黏膜上皮細胞微絨毛排列較整齊，斷裂少見，黏膜下微靜脈內皮細胞未見明顯異常。結論 DSCS手術可降低肝前型門靜脈高壓犬食管麯張靜脈壓力，改善胃黏膜及黏膜下微循環血管超微結構。
목적 관찰위거문정맥순배단류술（de-splanchnic circulation of the stomach，DSCS）대간전형문정맥고압견위점막급점막하미순배혈관초미결구적영향。방법 장12지성년잡충견안조“리종방법”（문정맥축착일반，사선인기문정맥만성혈전형성）제작견간전형문정맥고압식관정맥곡장모형，병우건모후4주조영검사측지순배급곡장정맥형성정황。성모후수궤분위량조，분별행분문주위혈관리단술화DSCS수술，우개복후、수술후즉각급술후4주말측정식관곡장정맥압력，수술전、수술후4주말측정간공능지표。술후4주말취위조직진행투사전경관찰。결과 DSCS수술조식관곡장정맥압력유술전적(22.1±0.9) cm H2O강지술후4주적(17.8±0.4) cm H2O，차이유통계학의의(P＜0.01)。수술전후간공능지표변화불명현(P＞0.05)。초미결구현시분문주위혈관리단술조위점막상피세포미융모단렬、탈락，미융모명현감소，점막하미정맥내피세포기막후박불균차불련속，내피세포간극가견명현홍세포취집；이DSCS조위점막상피세포미융모배렬교정제，단렬소견，점막하미정맥내피세포미견명현이상。결론 DSCS수술가강저간전형문정맥고압견식관곡장정맥압력，개선위점막급점막하미순배혈관초미결구。
Objective To evaluate the effect of de-splanchnic circulation of the stomach (DSCS) on ultramicrostructure of gastric mucosa and submucosal microcirculation in prehepatic portal hypertensive canine models. Methods Twelve prehepatic portal hypertensive canine models were established by half constriction and silk line chronic embolization of the portal vein. The esophageal varices and collateral circulation were observed by venography after 4 weeks. Dogs with established model were divided into pericardial devascularization group and DSCS group randomly. Esophageal variceal pressure (VP) was measured when the abdoman was open immediately before the abdoman was closed and 4 weeks after the operation respectively. The liver function was also tested preoperatively and 4 weeks postoperatively. The ultrastructure of gastric mucosa and submucosal microcirculation was observed by transmission electron microscope.Results The VP decreased significantly from (22. 1 ± 0.9 ) cm H2O to (17. 8 ± 0. 4) cm H2O after DSCS ( P ＜ 0. 01 ). There were no obvious different changes in the liver function preoperatively and postoperatively ( P ＞ 0. 05 ) in pericardial devascularization group. The microvillus of gastric epithelium cells were interrupted and fell off and that microvillus significantly reduced. Moreover, it was also shown that the basal lamina of submucosal veinule endothelial cells were uneven thick and discontinuous and that red blood cells could be obviously gathered in the endothelial cells interspace. While there were less severe damages in the gastric musosa epithelia and submucosal venule endothelial cells in DSCS group. Conclusions DSCS procedure can significantly decrease espophageal variceal pressure and improve the ultramicrostructure of gastric mucosa and submucosal microcirculation in canine models with prehepatic portal hypertension.
