【摘要】目的 探討肝移植門靜脈再灌注過程中肝動(dòng)脈缺血（hepatic artery ischemia，HAI）損傷的嚴(yán)重性和應(yīng)用肝動(dòng)脈橋式置管（hepatic artery bridgeconduit，HABC）技術(shù)實(shí)現(xiàn)門靜脈、肝動(dòng)脈同時(shí)灌注對(duì)這一損傷的保護(hù)作用。
方法 32只犬按隨機(jī)數(shù)字表法隨機(jī)均分為4組： 正常對(duì)照組、HAI 30 min組、HAI 2 h組和HABC組。后三組分別建立犬自體原位肝臟移植模型，HABC組應(yīng)用HABC技術(shù)使肝動(dòng)脈、門靜脈同時(shí)再灌注。術(shù)后取供肝組織與膽管組織電鏡觀察肝細(xì)胞和膽管上皮細(xì)胞病理學(xué)改變。分別應(yīng)用硫代巴比妥酸法檢測肝組織中丙二醛（MDA）濃度、黃嘌呤氧化酶法檢測過氧化物歧化酶（SOD）活性、酶標(biāo)記法檢測肝細(xì)胞線粒體琥珀酸脫氫酶（SDH）活性。
結(jié)果 HAI 30 min即可見供肝肝細(xì)胞和膽管上皮細(xì)胞水腫、線粒體嵴減少，HAI 2 h其病理改變進(jìn)一步加重，膽管上皮尤為明顯，而HABC組則見肝細(xì)胞和膽管上皮細(xì)胞比較完整，膽管上皮絨毛豐富。HAI 30 min組和HAI 2 h組肝組織中MDA含量增加，分別為（1.652±0.222） nmol/mg prot和（2.379±0.526） nmol/mg prot，而SOD則降低至（11.15±3.9） U/mg prot和（9.47±3.4) U/mg prot，SDH活性則分別降低至0.362±0.019和0.281±0.029，與正常對(duì)照組比較差異有統(tǒng)計(jì)學(xué)意義（P＜0.05，P＜0.01）； 而HABC組MDA含量、SOD和SDH活性與正常對(duì)照組比較差異無統(tǒng)計(jì)學(xué)意義（P gt;0.05）。
結(jié)論 HABC技術(shù)的實(shí)施，可為臨床肝移植中預(yù)防HAI損傷，減少肝移植術(shù)后并發(fā)癥，特別是膽道并發(fā)癥的發(fā)生提供有效的方法。
引用本文： 黎一鳴,徐金鍇,吉鴻,徐心,侯崇智. 門靜脈、肝動(dòng)脈同時(shí)灌注對(duì)供肝動(dòng)脈缺血損傷的保護(hù)作用. 中國普外基礎(chǔ)與臨床雜志, 2005, 12(5): 473-476下轉(zhuǎn)479. doi: 復(fù)制
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- 3. Margarit C, Hidalgo E, Lazaro JL, et al. Biliary complications secondary to late hepatic artery thrombosis in adult liver transplant patients [Ｊ]. Transpl Int, 1998; 11(Suppl 1)∶S251.
- 4. Massarollo PC, Mies S, Raia S. Simultaneous arterial and portal revascularization in liver transplantation [Ｊ]. Transplant Proc, 1998; 30(6)∶2883.
- 5. Schleimer K, Stippel DL, Kasper HU, et al. Improved microcirculation of a liver graft by controlled portal vein arterializa（下轉(zhuǎn)第479頁） （上承第476頁）tion [Ｊ]. J Surg Res, 2004; 116(2)∶202.
- 6. van As AB, Lotz Z, Tyler M, et al. Reperfusion injury associated with portal venous and hepatic arterial perfusion in liver transplantation [Ｊ]. Transplantation, 2002; 74(2)∶158.
- 7. Miyagawa Y, Imamura H, Soeda J, et al. Fate of hepatocyte and sinusoidal lining cell function and kinetics after extended cold preservation and transplantation of the rat liver [Ｊ]. Liver Transpl, 2002; 8(4)∶370.
- 8. Ardizzone G, Andorno E, Demartini M, et al. Portal vein pressure and graft oxygen consumption monitoring during liver transplantation [Ｊ]. Transplant Proc, 2003; 35(8)∶3015.
- 9. 陳主初主編. 病理生理學(xué) [M]. 第1版. 北京： 人民衛(wèi)生出版社，2001∶92.
- 10. Kojima N, Sato M, Suzuki A, et al. Enhanced expression of B71, B72, and intercellular adhesion molecule 1 in sinusoidal endothelial cells by warm ischemia/reperfusion injury in rat liver [Ｊ]. Hepatology, 2001; 34(4 Pt 1)∶751.
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