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Studies on hepatic resectability and the interruption of hepatic blood inflow in dogs with obstructive jaundice

梗阻性黄疸犬肝脏可切除性和肝血流阻断的研究

基本信息

批准号：
01480324
负责人：
MIZUMOTO Ryuji
金额：
$ 0.9万
依托单位：
Mie University
依托单位国家：
日本
项目类别：
Grant-in-Aid for General Scientific Research (B)
财政年份：
1989
资助国家：
日本
起止时间：
1989 至 1991
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-01480324/
关键词：
functional resectabity of the liver function of sinusoidal lining cell of the liver hepatic artery interruption major hepatic necrosis portal stasis ischemia-reperfusion injury free radical free radical scavenger 黄疸遷延肝予備力低下肝微細構造 si

项目摘要

Obstructive jaundice was produced in adult mongrel dogs by cholecystectomy and ligation-cut off of the di!ktal common bile duct, and the resectability and the tolerable limit of interruption of hepatic blood inflow in the liver with obstructive jaundice were functionally and morphologically evaluated.(1) Resectability of the liver with obstructive jaundice : When hepatectomy was performed with choledochoduodenostomy 2 weeks after production of obstructive jaundice, the 4-week survival rate was : 71% after 40% hepatectomy and 22% after 70% hepatectomy, respectively. The IGGRmax value before hepatectomy clearly indicated the limit of one-staged hepatectomy. On the other hand, when the choledochoduodenostomy for reduction of jaundice prior to hepatectomy was performed 3 weeks after production of obstructive jaundice, followed by 70% hepatectomy, many dogs that received hepatectomy 2 weeks after choledochoduodenostomy died within 4 weeks after two-staged hepatectomy, because of the insuffi … More cient of the reticuloendothelial' system and the coagulation-fibrinolysis system even if the hepatic reserve had been restored above the critical level. The 4-week survival rate. in dogs that underwent hepatectomy 3 weeks after the choledochoduodenostomy was significantly better at 67%.(2) Tolerable limit of interruption of the hepatic blood inflow : When the blood supply of the liver was interrupted simultaneously with choledochoduodenostomy 2 or 3 weeks after production of obstructive jaundice, the tolerable limits of interruption 2 and 3 weeks after production of, jaundice were 2 hours and I hour, respectively, in the hepatic artery, 20 and 10 minutes in the portal vein, and 10 and 5 minutes in both the hepatic artery and portal vein. The tolerable limit of interruption shortened as the duration of jaundice was longer. Especially, in the dogs that received interruption of the hepatic artery, the cause of death was extensive neurosis of the liver, and the choledochoduodenostomy was not effective even if those that survived, with electron microscopy suggesting significant prolongation of jaundice as compared with the dogs that received the choledochoduodenostomy alone.(3) Hepatic resectability after interruption of the hepatic blood inflow and reperfusion : In dogs that received 40% hepatectomy and the choledochoduodenostomy after 5- or 10-minute simultaneous interruption of the hepatic artery and the portal vein followed by 60-minute reperfusion 2 or 3 weeks after production of obstructive jaundice, the 1-week survival rate was significantly lower than in those that received the choledochoduodenostomy alone (40% and 20% 2 and 3 weeks, respectively, after production of jaundice). In the former group, lipid peroxides levels of the liver tissue and blood of were increased at both times, respectively. However, the survival rate improved, and the liver injury was milder, when a free radical scavenger such us Coenzyme Q_<10>, Superoxide dismutase and so on was administered before interruption of the hepatic blood inflow. Less

通过胆囊切除术和结扎-切断犬的双腔静脉，在成年杂种犬中制造梗阻性黄疸。对梗阻性黄疸时肝内血流中断的可切除性和耐受限度进行功能和形态学评价。(1)梗阻性黄疸肝脏的可切除性：梗阻性黄疸发生后2周行肝切除并胆总管十二指肠吻合术，4周生存率：40%肝切除术后为71%，70%肝切除术后为22%。术前IGGRmax值明显提示了一期肝切除术的限度。另一方面，当在梗阻性黄疸发生后3周行胆总管十二指肠吻合术以减少黄疸，然后进行70%肝切除术时，许多在胆总管十二指肠吻合术后2周接受肝切除术的狗在两阶段肝切除术后4周内死亡，原因是胆总管十二指肠吻合术后的胆汁中的胆汁不足。 ...更多信息即使肝脏储备已恢复到临界水平以上，网状内皮系统和凝血-纤溶系统仍然缺乏。4周生存率。在胆总管十二指肠吻合术后3周行肝切除术的犬中，(2)肝血流中断的容许限度：当梗阻性黄疸发生后2或3周同时阻断肝血供并行胆总管十二指肠吻合术时，黄疸发生后2周和3周肝动脉阻断的耐受限度分别为2小时和1小时，门静脉阻断的耐受限度分别为20分钟和10分钟，肝动脉和门静脉分别为10分钟和5分钟。黄疸持续时间越长，耐受中断时间越短。特别是，在接受肝动脉阻断的犬中，死亡原因是广泛的肝脏神经官能症，即使存活的犬，胆总管十二指肠吻合术也无效，与仅接受胆总管十二指肠吻合术的犬相比，电子显微镜显示黄疸明显延长。(3)肝血流中断和再灌注后的肝切除术：在阻塞性黄疸发生2或3周后，对接受40%肝切除术和胆总管十二指肠吻合术的狗同时阻断肝动脉和门静脉5或10分钟，然后再灌注60分钟，1周存活率明显低于单纯胆总管十二指肠吻合术组（黄疸发生后2周和3周分别为40%和20%）。在前一组中，肝组织和血液中的脂质过氧化物水平分别在两个时间点升高。在阻断肝血流前给予自由基清除剂如辅酶Q_1、超氧化物歧化酶等，可提高存活率，减轻肝损伤<10>。少