CAJ | 학술논문

目的：初步研究入肝门静脉完全动脉化加门腔分流术对大鼠肝脏的损害程度。方法100只肝硬化造模大鼠随机分为A组（n=40），入肝门静脉完全动脉化（PVA）+门腔分流（PCS）；B组（n=40），仅行门腔完全分流；C组（n=20），门静脉阻断30 min+右肾切除。分别将各组大鼠术前和术后1、2、4、8周的肝组织切片行肝细胞诱导型一氧化氮合成酶（iNOS）免疫组织化学染色，然后进行图像分析。各取8只正常大鼠，分别于PVA术前及术后4、8周行肝组织切片，马松染色后分析正常大鼠PVA手术前后肝脏纤维增生情况。结果（1）A组2只（5%）大鼠肝脏切片中常规HE染色可见汇管区明显扩张，小叶间静脉内径显著扩张，静脉壁增厚明显，壁内可见红染的纤维增生。（2）大鼠刚完成肝硬化造模时，肝细胞胞质的iNOS表达至峰值，3组平均IOD达600583±32828；3组大鼠术后均较术前有明显下降，差异有统计学意义（P＜0.01）；术后4周内， A组仍明显高于B、C两组，差异有统计学意义（P＜0.01）；至术后8周时，3组iNOS表达差异无统计学意义。（3）正常大鼠肝间质胶原纤维染色在术前及术后4、8周的总累积光密度值差异无统计学意义。结论术后8周内，PVA不会导致正常大鼠肝间质纤维化增加，可使部分肝硬化大鼠汇管区及小叶间静脉壁纤维化；PVA对肝细胞的损害主要集中在术后4周内，待肝脏对新的血流动力学改变及其相应的影响达到稳态后，PVA对肝脏的损害则不明显。
목적：초보연구입간문정맥완전동맥화가문강분류술대대서간장적손해정도。방법100지간경화조모대서수궤분위A조（n=40），입간문정맥완전동맥화（PVA）+문강분류（PCS）；B조（n=40），부행문강완전분류；C조（n=20），문정맥조단30 min+우신절제。분별장각조대서술전화술후1、2、4、8주적간조직절편행간세포유도형일양화담합성매（iNOS）면역조직화학염색，연후진행도상분석。각취8지정상대서，분별우PVA술전급술후4、8주행간조직절편，마송염색후분석정상대서PVA수술전후간장섬유증생정황。결과（1）A조2지（5%）대서간장절편중상규HE염색가견회관구명현확장，소협간정맥내경현저확장，정맥벽증후명현，벽내가견홍염적섬유증생。（2）대서강완성간경화조모시，간세포포질적iNOS표체지봉치，3조평균IOD체600583±32828；3조대서술후균교술전유명현하강，차이유통계학의의（P＜0.01）；술후4주내， A조잉명현고우B、C량조，차이유통계학의의（P＜0.01）；지술후8주시，3조iNOS표체차이무통계학의의。（3）정상대서간간질효원섬유염색재술전급술후4、8주적총루적광밀도치차이무통계학의의。결론술후8주내，PVA불회도치정상대서간간질섬유화증가，가사부분간경화대서회관구급소협간정맥벽섬유화；PVA대간세포적손해주요집중재술후4주내，대간장대신적혈류동역학개변급기상응적영향체도은태후，PVA대간장적손해칙불명현。
Objective To compare liver damage following portal vein arterialization (PCS) and portocaval shunt (PCS) in normal and cirrhotic rats. Methods One hundred cirrhotic rats were randomly divided into three groups:Group A (n=40), PVA+PCS;Group B (n=40), PCS only;Group C (n=20), portal vein blocking for 30 minutes plus right nephrectomy. Labeling index of inducible nitric oxide synthase (iNOS) was measured and analyzed before and 1, 2, 4, 8 weeks after the operation in each group respectively. Another 24 normal rats were randomly evenly divided into three groups. Collagenous fiber expression of each liver tissue was assessed by Masson trichrome stain and analyzed by Image-Pro Plus before and 4, 8 weeks after the operation. Results (1) Two (5%) cirrhotic rats were detected proliferation of fibrotic tissue at portal area by HE stain in Group A. (2) The cirrhotic rats showed the highest values of iNOS (SUM IOD:600 583±32 828) before the operation, but they decreased obviously over time after surgery in the three groups(P<0.01). However, the values of iNOS in Group A were significantly higher than the other two groups within postoperative 4 weeks(P<0.01). Until 8 weeks postoperatively, there was no significant difference between Group A and the other two non-PVA groups. (3)There was no significant difference in the sum IOD of liver collagenous fiber expression gained from masson trichrome stain before the operation and the other two postoperative moments in normal rats. Conclusions The present findings indicate that PVA technique can not promote the expression of liver collagenous fiber in normal rats within postoperative 8 weeks. Proliferation of fibrotic tissue of portal area is found in 5%cirrhotic rats following PVA with PCS within postoperative 8 weeks. The most severe damages that PVA technique brings to the liver of cirrhotic rats are within postoperative 4 weeks, but they gradually become less obvious after the liver adapts to changes of blood dynamics.