扩大肝部分切除术后入肝门静脉动脉化对大鼠血流动力学的影响

doi:10.3877/cma.j.issn.1674-0793.2010.05.005

目的

对大鼠行扩大肝部分切除术后利用右肾动脉行入肝门静脉动脉化加门腔分流术，研究该术式对大鼠门静脉血流动力学的影响。

方法

Sprague-Dawley大鼠130只，分为A组（动脉化组）47只，行70%扩大肝部分切除术后，用右肾动脉行门静脉动脉化加门腔分流术；B组（肝切组）43只，行70%扩大肝部分切除及右肾切除，阻断门静脉10 min；C组（对照组）40只，仅行右肾切除及门静脉主干游离。分别于术后第2、7、14、28天检测门静脉压力、内径和血流量。

结果

A组及B组手术成功率分别为85.1%和93.0%，差异无统计学意义，C组手术成功率100%。术后各时间点A组与B、C组比较，入肝门静脉压力、门静脉内径、血流速度和入肝血流量变化均较后两组更明显（P<0.01）；A组入肝门静脉压力随时间推移有下降趋势，于术后第14天（12.7±0.7）cm H₂O达到稳态，与术后第28天（12.4±0.6）cm H₂O比较，差异无统计学意义；而A组门静脉内径、血流速度和入肝血流量在术后各时间点间相比差异无统计学意义。B组术后门静脉血流速度均较C组增快（P<0.05），门静脉血流量在术后14~28 d较C组增加（P<0.05）。

结论

大鼠扩大肝部分切除术后行入肝门静脉动脉化模型稳定可靠，手术成功率理想，动脉化术后门静脉压力明显升高，门静脉内径出现扩张以适应压力变化，入肝血流量明显增加。门静脉血流动力学指标在术后早期即发生改变并取得稳态。

关键词: 肝切除, 门静脉动脉化, 门静脉压力, 血流动力学

Ojective

To investigate the effects of portal vein arterialization(PVA) associated with portacaval shunt after extended hepatectomy on hepatic hemodynamics.

Methods

One hundred and thirty Sprague-Dawley rats were randomly assigned to three groups. Group A(PVA group), PVA associated with portocaval shunt after 70% PH; Group B(PH group),70% PH associated with right nephrectomy; Group C(control group), right nephrectomy only. The success rate of operation was and calculated, the pressure, diameter, blood flow velocity and inflow blood of portal vein were investigated at day 2, 7, 14, 28 days after operation, respectively.

Results

The success rate of operation in Group A, B and Group C were 85.1%, 93% and 100%, respectively. There was no significant difference between Group A and B. In Group A, the pressure, diameter, blood flow velocity and blood inflow of portal vein increased significantly and kept a stable higher level after surgery compared with the other two groups, P<0.01. The portal vein pressure reached the peak at postoperative 2 days and fell slowly with the passage of time, then remained stably 14 days after surgery in Group A. From postoperative 14 to 28 days, the blood inflow of portal vein in Group B were higher than Group C, P<0.05. And blood flow velocity in Group B was always faster than Group C after surgery.

Conclusion

The risk of PVA associated with portocaval shunt after extended hepatectomy procedure is not increased, the hymodynamics of the portal vein achieve a new balance at a higher level in 2 days and kept stable within 28 days after surgery.

Key words: Hepatectomy, Portal Vein Arterialization, Portal vein pressure, Hemodynamics

图4 大鼠70%肝部分切除，切除肝左外叶及左内+中叶

表1 3组大鼠术后入肝脏门静脉压力（cm H₂O）（n=10，±s）

组别	术后第2天	术后第7天	术后第14天	术后第28天
A	13.7±0.6^*	13.2±0.6^*#	12.7±0.7^*△	12.4±0.6^*△☆
B	11.4±0.7	11.4±0.8	11.2±0.6	11.2±0.7
C	10.8±0.5	11.2±0.4	11.2±0.7	10.9±0.3

表1 3组大鼠术后入肝脏门静脉压力（cm H₂O）（n=10，±s）

组别	术后第2天	术后第7天	术后第14天	术后第28天
A	13.7±0.6^*	13.2±0.6^*#	12.7±0.7^*△	12.4±0.6^*△☆
B	11.4±0.7	11.4±0.8	11.2±0.6	11.2±0.7
C	10.8±0.5	11.2±0.4	11.2±0.7	10.9±0.3

图7 门静脉动脉化后可见血流由腹主动脉如肾动脉进入门静脉，门静脉内径扩张

表2 3组入肝门静脉内径、最大血流速、血流量的情况（±s, n=10）

时间点	D(cm)			V(cm/s)			PVF (ml/min)
时间点	A组	B组	C组	A组	B组	C组	A组	B组	C组
术后2 d	0.228±0.018^*	0.136±0.014	0.134±0.012	28.67±1.23^*	13.11±1.05^#	12.79±0.80	40.11±5.40^*	6.53±1.17	6.39±1.36
术后7 d	0.236±0.014^*	0.135±0.009	0.135±0.010	28.22±0.88^*	13.17±1.14^#	12.87±0.78	42.30±5.06^*	6.47±1.06	6.23±1.42
术后14d	0.242±0.015^*	0.136±0.010	0.134±0.032	28.61±0.99^*	13.16±1.11^#	12.62±0.30	45.24±6.77^*	6.56±1.03^△	6.21±1.30
术后28 d	0.243±0.022^*	0.138±0.009	0.134±0.019	28.09±0.77^*	13.34±0.77^#	12.13±0.50	44.94±8.65^*	6.85±1.02^*	6.28±1.07

表2 3组入肝门静脉内径、最大血流速、血流量的情况（±s, n=10）

时间点	D(cm)			V(cm/s)			PVF (ml/min)
时间点	A组	B组	C组	A组	B组	C组	A组	B组	C组
术后2 d	0.228±0.018^*	0.136±0.014	0.134±0.012	28.67±1.23^*	13.11±1.05^#	12.79±0.80	40.11±5.40^*	6.53±1.17	6.39±1.36
术后7 d	0.236±0.014^*	0.135±0.009	0.135±0.010	28.22±0.88^*	13.17±1.14^#	12.87±0.78	42.30±5.06^*	6.47±1.06	6.23±1.42
术后14d	0.242±0.015^*	0.136±0.010	0.134±0.032	28.61±0.99^*	13.16±1.11^#	12.62±0.30	45.24±6.77^*	6.56±1.03^△	6.21±1.30
术后28 d	0.243±0.022^*	0.138±0.009	0.134±0.019	28.09±0.77^*	13.34±0.77^#	12.13±0.50	44.94±8.65^*	6.85±1.02^*	6.28±1.07

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Hymodynamics study with rats of portal vein arterialization after extended hepatectomy

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Hymodynamics study with rats of portal vein arterialization after extended hepatectomy