CAJ | 학술논문

目的观察慢性、梗阻性黄疸小型猪肝-胆切除术联合限流性部分门静脉动脉化(PPVA)术后肝脏储备功能的动态变化.方法利用梗阻性黄疸小型猪模型,模拟进行联合半肝切除的肝门部胆管癌扩大根治性手术.实验分组:无黄疸对照组(A组,n=4)、门静脉动脉化组(B组,n=4)及非门静脉动脉化组(C组,n=4).对照观察根治术中应用限流性PPVA在术后30 d内的吲哚菁绿15 min滞留率(ICG15),从而判断肝脏储备功能的动态变化.结果术前B、C组高于A组[(0.66±0.07)%、(0.64±0.09)%比(0.09±0.01)%,P＜0.01],术后第1天B组低于C高于A组[(0.59±0.11)%比(0.82±0.09)%、(0.18±0.04)%,P＜0.05、P＜0.01],术后第7天B组高于A组低于C组[(0.34±0.09)比(0.17±0.04)%、(0.69±0.11)%,P均＜0.05].术后第30天B组低于C组、与A组差异无统计学意义[(0.12±0.03)%比(0.22±0.03)%、(0.09±0.003)%,P＜0.01、P＞0.05].B组术后第7天低于术前[(0.34±0.09)%比(0.66±0.07)%,P＜0.01].结论限流性PPVA可促进慢性梗阻性黄疸小型猪肝-胆切除术后残肝储备功能的恢复.
목적 관찰만성、경조성황달소형저간-담절제술연합한류성부분문정맥동맥화(PPVA)술후간장저비공능적동태변화.방법 이용경조성황달소형저모형,모의진행연합반간절제적간문부담관암확대근치성수술.실험분조:무황달대조조(A조,n=4)、문정맥동맥화조(B조,n=4)급비문정맥동맥화조(C조,n=4).대조관찰근치술중응용한류성PPVA재술후30 d내적신타정록15 min체류솔(ICG15),종이판단간장저비공능적동태변화.결과 술전B、C조고우A조[(0.66±0.07)%、(0.64±0.09)%비(0.09±0.01)%,P＜0.01],술후제1천B조저우C고우A조[(0.59±0.11)%비(0.82±0.09)%、(0.18±0.04)%,P＜0.05、P＜0.01],술후제7천B조고우A조저우C조[(0.34±0.09)비(0.17±0.04)%、(0.69±0.11)%,P균＜0.05].술후제30천B조저우C조、여A조차이무통계학의의[(0.12±0.03)%비(0.22±0.03)%、(0.09±0.003)%,P＜0.01、P＞0.05].B조술후제7천저우술전[(0.34±0.09)%비(0.66±0.07)%,P＜0.01].결론 한류성PPVA가촉진만성경조성황달소형저간-담절제술후잔간저비공능적회복.
Objective To investigate the change of hepatic functional reserve (HFR) after flowcontrolled partial portal vein arterialization (PPVA) in hepato-biliary resection (HBR) in miniature pigs with obstructive jaundice. Methods Eight miniature-pig models with chronic gradually obstructive jaundice were divided into 2 groups with 4 pigs each: PPVA group (group B,n =4), non-PPVA group (group C, n = 4), and another 4 pigs without chronic gradually obstructive jaundice served as control group ( group A, n = 4). Approaches of EHBR with or without PPVA were done, then the effects of flow-controlled PPVA on HFR of remnant liver were studied by detecting indocyanine-green retention at 15 min ( ICG15 ) in 30 days post-operation. Results ICG15 in groups B and C was significantly higher than in group A pre-operation[(0.66±0.07)%, (0.64±0.09)% vs (0.09±0.01)%,P＜0.01]. ICG15 in group B was significantly lower than that in group C, and higher than in group A at the first day post-operation[(0. 59 ±0.11)% vs (0.82±0.09)%, (0.59±0.11)% vs (0. 18±0.04)%,P＜0. 05,P＜0. 01]. ICG15 in group B was significantly lower than in group C, and higher than in group A at 7th day post-operation [(0. 34±0.09)% vs (0.69 ±0. 11)%, (0.34±0.09)% vs (0. 17 ±0.04)% ,both P＜0.05]. ICG15 in group B was significantly lower than in group C, but showed no significant difference from group A at 30th day post-operation[(0.12 ±0.03)% vs (0.22 ±0.03)%, (0.12 ±0.03)% vs (0.09 ± 0. 003)% ,P ＜0. 01 ,P ＞ 0. 05]. ICG15 in group B on the 7th day post-operation was significantly lower than that pre-operation[(0. 34 ± 0. 09 ) % vs (0. 66 ± 0. 07 ) %, P ＜ 0. 01]. Conclusion Flow-controlled PPVA in HBR is beneficial to recovery of HFR on miniature pigs with obstructive jaundice.