Experimental study on clinical applications of preoperative embolization and intraoperative arterialization of portal vein during pancreatoduodenectomy with hepatectomy

我们已经评估了肝动脉-门静脉分流术是否有助于治疗肝血流阻塞时肝衰竭，使用成年杂交（杂交）狗。【对象与方法】我们准备了两组动物；第一组将肝动脉结扎切除，即肝动脉阻塞组（阻塞组，n=8），第二组将切除的肝动脉直接与部分静脉吻合，即部分门静脉动脉化组（动脉化组，n=12）。测定两组患者术前、术后即刻、术后30、60 min门静脉压、门静脉氧分压、门静脉血流、肝组织血流量及肝能代谢（AKBR），并进行比较。【结果】(1)门静脉压力（mm Hg）：动脉化组术前门静脉压力为6.6 mg Hg，术后分别为8.3、8.7、8.3。阻断组门静脉压力分别为术前5.9 mg Hg、6.8 mg Hg、5.4 mg Hg、术后6.3 mg Hg。两组间无显著差异。(2)门静脉分氧压（mmHg）：动脉化组门静脉分氧压术前为47.1 mmHg，术后为51.9、55.7、51.4。阻塞组门静脉分氧压术前为51.1 mm Hg，术后为48.2、46.7、49.2。动脉化组门静脉氧分压有升高的趋势，但两组间差异无统计学意义。然而，当计算D PO_2（%）时，假设术前水平为100%，动脉化组门静脉氧分压明显高于阻塞组（p<0.05）。(3)门静脉血流量（ml/min）动脉化组术前门静脉血流量为271.4 ml/min，术后为410、400、325.0 ml/min。阻断组术前门静脉血流量为410.0，术后为324.0、243.3、237.8。动脉化组门静脉血流有增加的趋势，而阻塞组门静脉血流有减少的趋势。两组间无显著差异。然而，当计算门静脉D血流量（%）时，假设术前水平为100%，动脉化组门静脉血流量明显高于阻塞组（p<0.05）。(4) AKBR：动脉化组AKBR术前1.0，术后1.1、0.9、0.8。堵塞组AKBR术前1.2，术后1.3、1.2、1.6。两组间无显著差异。(5)肝组织血流量（ml/min/100 mg）：动脉化组术前肝组织血流量18.0，术后15.6、14.1、9.3。阻塞组术前肝组织血流量15.6，术后15.8,15.8,12.2。两组间无显著差异。【讨论】假设术前水平为100%，动脉化组门静脉氧分压及门静脉血流变化率明显高于阻塞组（p<0.05）。这些结果表明，肝动脉-门静脉分流可以维持肝动脉阻塞后的肝血流量和氧供应，有助于预防肝衰竭。少

We have evaluated whether hepatic artery-portal vein shunt is useful for the treatment of hepatic failure when hepatic blood flow is blocked, using adult cross-bred (hybrid) dogs.[Subjects and Methods] We prepared two groups of animals ; in the first group, hepatic artery was ligated and resected, i.e., hepatic artery blockage group (blockage group, n=8), and in the second group, the resected hepatic artery was directly anastomosed to partal vein, i.e., partial portal arterialization group (arterialization group, n=12). Portal vein pressure, partial oxygen pressure of portal vein, portal vein blood flow, blood flow in liver tissues and hepatic energy metabolism (AKBR) were measured preoperatively, immediately after surgery, 30 and 60 minutes after surgery, and then, two groups were compared.[Results] (1) Portal vein pressure (mm Hg) : In the arterialization group, portal vein pressure was 6.6 mg Hg before surgery, 8.3,8.7,8.3 after surgery. In the blockage group, portal vein pressure w … More as 5.9 mg Hg before surgery, 6.8,5.4,6.3 after surgery. No significant differences were detected between the two groups. (2) Partial oxygen pressure of the portal vein (mmHg) : Partial oxygen pressure of the portal vein was 47.1 mm Hg before surgery, 51.9,55.7,51.4 after surgery, in the arterialization group. In the blockage group, partial oxygen pressure of the portal vein was 51.1 mm Hg before surgery, 48.2,46.7,49.2 after surgery. In the arterialization group, partial oxygen pressure of the portal vein tended to increase, but no significant differences were detected between the two groups. However, when D PO_2(%) was calcuated, assuming that the preoperative level was 100%, the partial oxygen pressure of the portal vein was significantly higher in the arterialization group than in the blockage group (p<0.05). (3) Portal vein blood flow (ml/min.) : In the arterialization group, portal vein blood flow was 271.4 ml/min before surgery, 410.0,400.0,325.0 after surgery. In the blockage group, portal vein blood flow was 410.0 before surgery, 324.0,243.3,237.8 after surgery. In the arterialization group, portal vein blood flow tended to increase, whereas portal vein blood flow tended to decrease in the blockage group. No significant differences were detected between the two groups. However, when D portal vein blood flow (%) was calculated, assuming that the preoperative level was 100%, the portal vein blood flow was significantly higher in the arterialization group than in the blockage group (p<0.05). (4) AKBR : In the arterialization group, AKBR was 1.0 preoperatively, 1.1,0.9,0.8 after surgery. In the blockage group, AKBR was 1.2 preoperatively, 1.3,1.2,1.6 after surgery. No significant differences were detected between the two groups. (5) Blood flow in hepatic tissues (ml/min/100 mg) : In the arterialization group, blood flow in hepatic tisswues was 18.0 preoperatively, 15.6,14.1,9.3 after surgery. In the blockage group, blood flow in hepatic tissues was 15.6 preoperatively, 15.8,15.8,12.2 after surgery. No significant differences were detected between the two groups.[Discussion] The rates of changes in partial oxygen pressure of portal vein and portal vein blood flow were significantly higher in the arterialization group than in the blockage group (p<0.05), assuming that the preoperative level was 100%. These findings indicate that hepatic artery-portal vein shunt allows to maintain hepatic blood flow and oxygen supply following the blockage of hepatic artery and is useful for preventing hepatic failure. Less