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

成年杂种犬采用胆囊术加胆总管结扎断流术复制梗阻性黄疸模型，从功能和形态上评价梗阻性黄疸时肝血流阻断的可切除性和耐受性：(1)梗阻性黄疸肝脏的可切除性：梗阻性黄疸后2周行肝切除胆总管十二指肠吻合术，4周存活率分别为：40%肝切除71%，70%肝切除22%。术前IGGRmax值可明确提示一期肝切除的限度。另一方面，当在梗阻性黄疸发生后3周行肝切除前的胆总管十二指肠吻合术以减少黄疸时，随后进行70%的肝切除，许多在胆总管十二指肠吻合术后2周接受肝切除的狗在二期肝切除后4周内死亡，原因是…不充分。更了解网状内皮系统和凝血-纤溶系统，即使肝脏储备已恢复到临界值以上。4周存活率。在胆总管十二指肠吻合术后3周行肝切除的犬，肝血流阻断的耐受度为67%。(2)肝血流阻断耐受限度：梗阻性黄疸发生后2周和3周，肝动脉阻断供血的耐受限度分别为肝动脉2小时和1小时，门静脉20分钟和10分钟，肝动脉和门静脉均为10分钟和5分钟。黄疸持续时间越长，阻断的耐受性越短。特别是，在接受肝动脉阻断的狗中，死亡原因是广泛的肝脏神经官能症，即使存活下来，胆总管十二指肠吻合术也是无效的，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，黄疸显著延长。(3)肝血流阻断和再灌流后的肝脏可切除性：在阻塞性黄疸产生后，肝动脉和门静脉同时切断5或10分钟，然后再灌流60分钟2或3周后，接受40%肝切除和胆总管十二指肠吻合术的狗，术后1周存活率显著低于单纯胆总管十二指肠吻合术(分别为40%和20%)。前两组大鼠肝组织过氧化脂质和血液过氧化脂质水平在两个时间点均升高。而阻断肝血流前应用美国辅酶Q_(10)、超氧化物歧化酶等自由基清除剂，可提高存活率，减轻肝损伤。较少

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