摘要
目的 评价门奇静脉断流术(PAD)、门腔静脉侧侧分流术(PCS)、远端脾腔静脉分流术(DSCS)对门体分流率(PSS)、肝脏功能、肝脏线粒体功能和储备功能的影响,为合理选择手术方式提供理论依据。 方法 用四氯化碳／乙醇诱导大鼠肝硬化门静脉高压症模型,观察了各手术方式(PCS、DSCS、PAD)前后大鼠肝功能、PSS和肝细胞线粒体功能,并进行口服糖耐量试验(OGTT)、动脉血酮体比值(KBR)的测定,比较各组肝脏储备功能的变化。 结果 肝硬化门静脉高压时,PSS远高于正常,肝细胞线粒体功能和肝脏储备功能下降;术后第1周DSCS、PAD、PCS组OGTT 120 min血糖值分别为(12.2±2.6)、(12.4±2.8)和(12.6±2.7)mmol／L比肝硬化对照组(9.0±2.4)mmol／L有显著升高;而术后第2、3周DSCS和PAD两组OGTT 120 min血糖值与肝硬化对照组比较均差异无统计学意义,但PCS组OGTT 120 min血糖值仍然显著高于肝硬化对照组。三种手术组在术后1、2周时的KBR都显著低于肝硬化对照组(P<0.0 5或P<0.01),但术后第三周时仅PCS组的KBR值仍然显著低于肝硬化对照组(P<0.05)。PCS组术后肝细胞线粒体功能进一步下降且恢复慢。DSCS组和PAD组的上述指标变化小且恢复较快。 结论 PAD和DSCS都是较理想的手术方式。
Objective To evaluate the effects of portaazygous disconnection (PAD), portacaval shunt (PCS) and distal splenocaval shunt (DSCS) on the portosytemic shunting (PSS), hepatic function (HF), hepatic mitochondrial respiratory function (HMRF), oral glucose tolerance test (OGTT) and arterial ketone body ratio (KBR) in order to provide a sound basis for selecting suitable operations for patients. Methods Using a cirrhotic portal hypertensive model induced by CCl4/ethanol in Wistar rats, the PSS, HF, HMRF, OGTT and KBR were determined three weeks after PCS, DSCS and PAD. Results It was revealed that: (1) In the cirrhotic portal hypertension rats, the PSS increased significantly, HMRF and hepatic reserve function (HRF) decreased significantly when compared with the control rats. (2) At the time of first postoperative week, the mean blood glucose value in the 120-minute OGTT in each PAD, PCS and DSCS groups had significant differences compared with the cirrhotic control group (P < 0.05). But during the second and third postoperative weeks, the mean blood glucose values in the 120-minute OGTT in both PAD and DSCS groups had no significant differences compared with the cirrhotic control group (P > 0.05) except for the PCS group (P < 0.05). The values of KBR in the three operative groups decreased significantly compared with the cirrhotic control group during the two postoperative weeks (P < 0.05 or P < 0.01). In the third postoperative week, only the values of KBR in the PCS group had a significant difference (P < 0.05) compared with the cirrhotic control group. (3) After PCS, the PSS was further increased; HF and HMRF were significantly decreased. Little improvement was found in the third postoperative week. (4) After DSCS and PAD, the above mentioned indices were less influenced, and they were restored more quickly than those in the PCS group. Conclusion We found that PAD and DSCS are more desirable than PCS.
出处
《中华肝脏病杂志》
CAS
CSCD
北大核心
2005年第2期113-116,共4页
Chinese Journal of Hepatology
