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

梗阻性黄疸是由成年杂种犬胆囊切除术和结扎切断胆囊引起的。对梗阻性黄疸患者肝血流中断的可切除性和可耐受限度进行功能和形态学评价。(1)梗阻性黄疸肝的可切除性：梗阻性黄疸发生2周后行胆总管十二指肠吻合肝切除术，40%肝切除术后4周生存率为71%，70%肝切除术后4周生存率为22%。肝切除术前IGGRmax值明确提示一期肝切除术的局限性。另一方面，在梗阻性黄疸发生3周后行肝切除术前胆总管十二指肠吻合术减少黄疸，然后进行70%的肝切除术时，许多在胆总管十二指肠吻合术2周后行肝切除术的犬在两期肝切除术后4周内死亡。即使肝储备已恢复到临界水平以上，网状内皮系统和凝血-纤溶系统的功能仍会增强。4周存活率。在胆总管十二指肠吻合术后3周行肝切除术的狗，明显优于67%。(2)中断的容许极限肝血液流入:当肝脏的血液供应被中断与choledochoduodenostomy同时生产阻塞性黄疸2或3周后,中断的容许极限生产2和3周后,黄疸2小时,我小时,分别在肝动脉,20和门静脉10分钟,10分钟和5分钟在肝动脉和门静脉。随着黄疸持续时间的延长，中断的可容忍限度缩短。特别是，在肝动脉中断的狗中，死亡原因是广泛的肝脏神经症，即使存活下来，胆总管十二指肠吻合术也没有效果，电子显微镜显示与单独接受胆总管十二指肠吻合术的狗相比，黄疸明显延长。(3)肝血流再灌注中断后的肝可切除性：梗阻性黄疸发生2周或3周后，同时中断肝动脉和门静脉5分钟或10分钟，再灌注60分钟后，行40%肝切除术和胆总管十二指肠吻合术的犬，其1周生存率明显低于单独行胆总管十二指肠吻合术的犬（黄疸发生2周和3周后分别为40%和20%）。在前一组中，肝脏组织和血液中脂质过氧化物水平分别升高。而在肝血流中断前给予辅酶Q_<10>、超氧化物歧化酶等自由基清除剂可提高大鼠的存活率，且肝损伤较轻。少

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