摘要
目的:比较不同入肝血流阻断法行肝硬化大鼠肝切除的手术安全性及对肝脏、小肠损伤的影响。方法:大鼠采用CCl4加乙醇复合法诱导肝硬化模型后行Higgins法70%肝切除。根据术中肝血流阻断法的不同分为A组(Pringle法);B组(半肝血流阻断法);C组(保留半肝动脉血流阻断法);D组(门静脉转流保留半肝动脉血流阻断法),阻断时间均为30 min。比较各组手术成功率,肝切除24 h后动物存活率及肝细胞及小肠病理改变。结果:A、B、C、D组手术成功率各分别为90.9%(10/11)、76.9%(10/13)、80.3%(10/12)、76.9%(10/13),组间差异无统计学意义(P>0.05);肝切除术后24 h存活率分别为3/10(30%)、10/10(100%)、9/10(90%)、10/10(100%),B、C、D组大鼠存活率均明显高于A组(均P<0.05)。病理学结果显示,A组肝组织、小肠黏膜明显损伤,除C组小肠黏膜损伤与A组类似外,其他各组肝组织损伤均较A组轻微,且小肠黏膜基本无损伤。结论:在肝硬化大鼠肝切除中,采用半肝血流阻断法、保留半肝动脉血流阻断法、门静脉转流保留半肝动脉血流阻断法的手术安全性及肝损伤程度均优于Pringle法。
Objective： To compare the surgical safety of different hepatic inflow occlusion methods for hepatectomy in rats with liver cirrhosis and subsequent impairments to the liver and bowel. Methods： Rats with liver cirrhosis induced by CC14 plus ethanol underwent Higgins-Anderson 70% hepatectomy. According to different hepatic inflow occlusion methods used during operation, rats were divided into group A （using Pringle maneuver）, group B （using hemihepatic vascular occlusion）, group C （using hepatic inflow occlusion without hemihepatic artery control） and group D （using portal vein shunting hepatic inflow occlusion without hemihepatic artery control）, with 30-min occlusion time for all groups. The surgical success rate, 24-h posthepatectomy survival rate and postoperative pathological changes in the liver and small intestine among groups were compared.Results： In group A, group B, group C and group D, the surgical success rate was 90.9% （10/11）, 76.9% （10/13）, 83.3% （10/12） and 76.9% （10/13） respectively, and the difference among them had no statistical significance （P〉0.05）; the 24-h posthepatectomy survival rate was 3/10 （30%）, 10/10 （100%）, 9/10 （90%） and 10/10 （100%） respectively, and which in all the latter three group were significantly higher than that in group A （all P〈0.05）. Pathological examination showed that the liver and small intestinal mucosal tissue in group A were severely damaged, while in the remaining groups, except for the intestinal mucosal injury in group C was similar to that in group A, the liver injuries were all milder than that in group A, and the intestinal mucosal tissues had almost no pathological lesions. Conclusion： In liver resection for rats with liver cirrhosis, the surgical safety and degree of liver damage of either procedures of hemihepatic vascular occlusion, hepatic inflow occlusion without hemihepatic artery control and portal vein shunting hepatic inflow occlusion without hemihepatic artery control are superior to Pringle maneuver.
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2014年第1期58-63,共6页
China Journal of General Surgery
关键词
肝切除术
方法
肝硬化
大鼠
Hepatectomy/methods
Liver Cirrhosis
Rats
