中华实验外科杂志
中華實驗外科雜誌
중화실험외과잡지
CHINESE JOURNAL OF EXPERIMENTAL SURGERY
2014年
10期
2151-2154
,共4页
仇公才%郑万仁%李志鹏%李岩%曾兆林
仇公纔%鄭萬仁%李誌鵬%李巖%曾兆林
구공재%정만인%리지붕%리암%증조림
门静脉结扎%尾状叶%肝切除术
門靜脈結扎%尾狀葉%肝切除術
문정맥결찰%미상협%간절제술
Portal vein ligation%Caudate lobe%Hepatoectomy
目的 探讨选择性结扎大鼠除肝尾状叶以外的门静脉分支,使尾状叶增生代偿后,再行仅保留尾状叶的次全肝切除术的可行性和安全性.方法 将40只SD雄性大鼠随机分成实验组(结扎尾状叶以外的门静脉分支)和假手术对照组(仅开腹而不行门静脉结扎),术后第3、7、14、21天两组各5只大鼠采血检测谷丙转氨酶(ALT)、谷草转氨酶(AST)、白蛋白、总胆红素、直接胆红素水平,并处死大鼠,测量尾状叶比重.苏木素-伊红染色,光镜下观察实验组结扎侧与非结扎侧肝叶的病理形态变化,用免疫组织化学方法检测肝细胞增殖核抗原(Ki-67)的表达.另取实验组与对照组各20只大鼠第1次手术同前,但术后第21天均行仅保留肝尾状叶的次全肝切除术,术后统计两组生存率.结果 实验组大鼠ALT在术后第3、7、14天明显高于对照组[(57.28 ±8.95)比(165.07±19.15) U/L、(67.03±13.46)比(131.24±9.51) U/L、(67.03±13.46)比(100.16±5.20) U/L,P＜0.01],AST在术后第3、7、14天也高于对照组[(148.89±37.64)比(853.61±276.33) U/L、(146.34±39.06)比(730.19±169.81) U/L,P＜0.01;(143.13±23.30)比(129.82±18.80) U/L,P＜0.05],白蛋白在术后第7天有所降低[(39.65±2.49)比(25.91±2.21) g/L,P＜0.01].胆红素值两组差异无统计学意义(P＞0.05).肝尾状叶在术后前3d代偿增生速度最迅速,在术后7～14d达到平台期.行仅保留尾状叶的次全肝切除术后,实验组10d生存率为80％ (16/20),高于对照组的20％(4/20),两组的生存时间差异有统计学意义(P＜0.05).结论 通过选择性结扎SD大鼠除尾状叶以外的门静脉分支,使尾状叶代偿性增大后再行肝大部切除术安全可行.
目的 探討選擇性結扎大鼠除肝尾狀葉以外的門靜脈分支,使尾狀葉增生代償後,再行僅保留尾狀葉的次全肝切除術的可行性和安全性.方法 將40隻SD雄性大鼠隨機分成實驗組(結扎尾狀葉以外的門靜脈分支)和假手術對照組(僅開腹而不行門靜脈結扎),術後第3、7、14、21天兩組各5隻大鼠採血檢測穀丙轉氨酶(ALT)、穀草轉氨酶(AST)、白蛋白、總膽紅素、直接膽紅素水平,併處死大鼠,測量尾狀葉比重.囌木素-伊紅染色,光鏡下觀察實驗組結扎側與非結扎側肝葉的病理形態變化,用免疫組織化學方法檢測肝細胞增殖覈抗原(Ki-67)的錶達.另取實驗組與對照組各20隻大鼠第1次手術同前,但術後第21天均行僅保留肝尾狀葉的次全肝切除術,術後統計兩組生存率.結果 實驗組大鼠ALT在術後第3、7、14天明顯高于對照組[(57.28 ±8.95)比(165.07±19.15) U/L、(67.03±13.46)比(131.24±9.51) U/L、(67.03±13.46)比(100.16±5.20) U/L,P＜0.01],AST在術後第3、7、14天也高于對照組[(148.89±37.64)比(853.61±276.33) U/L、(146.34±39.06)比(730.19±169.81) U/L,P＜0.01;(143.13±23.30)比(129.82±18.80) U/L,P＜0.05],白蛋白在術後第7天有所降低[(39.65±2.49)比(25.91±2.21) g/L,P＜0.01].膽紅素值兩組差異無統計學意義(P＞0.05).肝尾狀葉在術後前3d代償增生速度最迅速,在術後7～14d達到平檯期.行僅保留尾狀葉的次全肝切除術後,實驗組10d生存率為80％ (16/20),高于對照組的20％(4/20),兩組的生存時間差異有統計學意義(P＜0.05).結論 通過選擇性結扎SD大鼠除尾狀葉以外的門靜脈分支,使尾狀葉代償性增大後再行肝大部切除術安全可行.
목적 탐토선택성결찰대서제간미상협이외적문정맥분지,사미상협증생대상후,재행부보류미상협적차전간절제술적가행성화안전성.방법 장40지SD웅성대서수궤분성실험조(결찰미상협이외적문정맥분지)화가수술대조조(부개복이불행문정맥결찰),술후제3、7、14、21천량조각5지대서채혈검측곡병전안매(ALT)、곡초전안매(AST)、백단백、총담홍소、직접담홍소수평,병처사대서,측량미상협비중.소목소-이홍염색,광경하관찰실험조결찰측여비결찰측간협적병리형태변화,용면역조직화학방법검측간세포증식핵항원(Ki-67)적표체.령취실험조여대조조각20지대서제1차수술동전,단술후제21천균행부보류간미상협적차전간절제술,술후통계량조생존솔.결과 실험조대서ALT재술후제3、7、14천명현고우대조조[(57.28 ±8.95)비(165.07±19.15) U/L、(67.03±13.46)비(131.24±9.51) U/L、(67.03±13.46)비(100.16±5.20) U/L,P＜0.01],AST재술후제3、7、14천야고우대조조[(148.89±37.64)비(853.61±276.33) U/L、(146.34±39.06)비(730.19±169.81) U/L,P＜0.01;(143.13±23.30)비(129.82±18.80) U/L,P＜0.05],백단백재술후제7천유소강저[(39.65±2.49)비(25.91±2.21) g/L,P＜0.01].담홍소치량조차이무통계학의의(P＞0.05).간미상협재술후전3d대상증생속도최신속,재술후7～14d체도평태기.행부보류미상협적차전간절제술후,실험조10d생존솔위80％ (16/20),고우대조조적20％(4/20),량조적생존시간차이유통계학의의(P＜0.05).결론 통과선택성결찰SD대서제미상협이외적문정맥분지,사미상협대상성증대후재행간대부절제술안전가행.
Objective To assess the safety and effectiveness of caudate lobe-sparing subtotal hepatoectomy after rapid hypertrophy of the caudate lobe following selective portal vein branches ligation except caudate lobe's in rats.Methods Forty SD rats were randomly divided into portal vein branches ligation group and sham group.Portal vein branches except caudate lobe's were ligated by laparotomy.Alanine transaminase (ALT),aspartate aminotransferase (AST),albumin,total bilirubin and direct bilirubin were assessed at 3rd,7th,14th and 21st day after portal vein ligation in 5 rats each day,followed by rats sacrifice.The morphological changes of both ligated and non-ligated liver lobes were observed by microscope.The expression of proliferation cell nuclear antigen (Ki-67) was detected by immunohistochemistry.Twenty-one days after the first operation,caudate lobe-sparing subtotal hepatoectomy was undertaken on other 20 rats of each group.Survival rate was assessed in both groups after the second operation.Results ALT levels were higher in experimental group than in control group on the 3rd,7th and 14th day [(57.28 ± 8.95) vs.(165.07±19.15)U/L,(67.03 ±13.46) vs.(131.24±9.51) U/L,and (67.03 ±13.46) vs.(100.16 ± 5.20) U/L,P ＜ 0.01].AST levels were also elevated on the 3rd,7th and 14th day [(148.89±37.64) vs.(853.61 ±276.33) U/L,(146.34 ±39.06) U/Lvs.(730.19 ±169.81) U/L,P ＜0.01 ; (143.13 ±23.30) vs.(129.82 ± 18.80) U/L,P ＜0.05].Albumin levels were only elevated at day 7 [(39.65 ± 2.49) vs.(25.91 ± 2.21) g/L,P ＜ 0.01].Total bilirubin and direct bilirubin showed no significant diffence between two groups.The hypertrophy rate of caudate lobe was very quick in former 3 days,and then got slower on the day 14.The experimental group had a higher survival rate of 10 days (16/20 vs.4/20,P ＜ 0.01).Conclusion It is safe and effective to undertake caudate lobe-sparing subtotal hepatoectomy after selective portal vein branches ligation in rats.
