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安全开展肝血流阻断术是人们关注的问题。为指导临床工作,本实验共用59只家兔进行研究。分3个实验组,分别或同时结扎肝动脉、门静脉右叶分枝,观察术后肝脏重量、组织学、超微结构及血清酶活性的变化,並选择性作血管造影,了解血流阻断情况。 实验结果为:1.肝动脉分枝结扎后早期,结扎叶均发生不同程度的梗死。总的趋势可分为两型:恢复型(占本组55.6％)和梗死型(占本组的44.4％);门静脉分枝结扎后引起结扎叶的萎缩、非结扎叶代偿性肥大,两者处于相对的平衡状态;两种血管同时被结扎后,83％动物的梗死区占据整个结扎叶,仅3只残留有部分色泽尚正常的肝组织。 2.肝动脉、门静脉分枝同时结扎组与单个血管结扎组比较,术后第3天血清GPT活性相差显著(P<0.01)。 3.肝动脉分枝结扎后第25天,动脉侧枝循环已经建立,门静脉分枝结扎后则未见入肝的侧枝循环形成。 4.20％左右肝组织发生急性梗死对于家兔是可以耐受的。 本文认为:1.肝动脉结扎术存在一定的危险性。在肝动脉血流完全阻断情况下,从术前、术中开始提供改善门静脉血流淤滞状态、增强肝细胞对低氧血症抵抗力的措施可以减轻术后肝梗死的严重程度。 2.门静脉分枝结扎对机体不产生严重的影响,这种手术方式是安全的,在临床上可以开展。 3.同时结扎肝动脉、门静脉肝叶
Safe implementation of hepatic blood flow blockade is a matter of concern. To guide clinical work, 59 rabbits were used for this study. In three experimental groups, branches of hepatic artery and right portal vein were ligated at the same time or at the same time. Changes of liver weight, histology, ultrastructure and serum enzyme activity were observed after operation, and selective angiography was performed to understand the blood flow blockage. Happening. The experimental results are as follows:1. Early after ligation of the hepatic artery, ligation of the ligation occurred in different degrees. The general trend can be divided into two types: recovery type (55.6% of this group) and infarct type (44.4% of this group); ligation of the portal vein leads to atrophy of the ligation leaf, compensatory hypertrophy of the non-ligation leaf, and two The subjects were in a relatively balanced state; after the two blood vessels were ligated at the same time, the infarct zone of the 83% animal occupied the entire ligation leaf, and only 3 of the liver tissues remained part of the normal color liver tissue. 2. Compared with the single vessel ligation group, the serum GPT activity on the 3rd postoperative day was significantly different (P<0.01). 3. On the 25th day after the ligation of the hepatic artery, the collateral circulation of the arteries was established. After the branches of the portal vein were ligated, no collateral circulation to the liver was formed. About 4.20% of acute infarctions in liver tissue can be tolerated in rabbits. This article believes: 1. Hepatic artery ligation is a certain risk. In the case of complete obstruction of hepatic arterial blood flow, measures to improve the stasis of portal vein blood flow and enhance the resistance of hepatocytes to hypoxemia can reduce the severity of postoperative liver infarct from before and during surgery. 2. Portal vein branching and ligation does not have a serious impact on the body. This surgical procedure is safe and can be carried out clinically. 3. Simultaneously ligation of hepatic artery, portal vein and liver lobe