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

[对象与方法]我们用成年杂种犬评价了肝动脉-门静脉分流术在肝血流阻断时对肝功能衰竭的治疗作用。[对象和方法]我们准备了两组动物：第一组，肝动脉结扎切除，即肝动脉阻断组(n=8)；第二组，切除的肝动脉直接与门静脉吻合，即部分门脉动脉化组(n=12)。分别于术前、术后即刻、术后30、60min测定门静脉压力、门静脉血氧分压、门静脉血流量、肝组织血流量及肝能量代谢(AKBR)，并进行比较。[结果](1)门静脉压力(Mm Hg)：动脉化组门静脉压力术前6.6 mg Hg，术后8.3 mg Hg，8.37 mg Hg。阻断组门静脉压力与…术前高达5.9 mg汞，术后6.8、5.4、6.3 mg汞。两组间差异无统计学意义。(2)门静脉血氧分压：动脉化组门静脉血氧分压术前47.1 mm Hg，术后51.9 mm Hg，55.7 mm Hg，51.4 mm Hg。阻断组术前门静脉血氧分压为51.1 mm Hg，术后为48.2、46.7、49.2。动脉化组门静脉血氧分压有升高趋势，但两组间差异无统计学意义。但当计算DPO_2(%)时，假设术前水平为100%，动脉化组的门静脉血氧分压显著高于阻断组(p&lt；0.05)。(3)门静脉血流量(m l/m in.)：动脉化组门静脉血流量术前为271.4 m l/m in，术后为410.0、400.0、325.0。阻断组术前门静脉血流量为410.0，术后分别为324.0、243.3、237.8。动脉化组门静脉血流量呈增加趋势，而闭塞组门静脉血流量呈下降趋势。两组间差异无统计学意义。然而，当计算门静脉血流量(%)时，假设术前水平为100%，动脉化组的门静脉血流量明显高于闭塞组(p&lt；0.05)。(4)AKBR：动脉化组术前AKBR为1.0，术后为1.1，0.9，0.8。闭塞组AKBR术前1.2，术后1.3，1.2，1.6。两组间差异无统计学意义。(5)肝组织血流量(ml/min/100 mg)：动脉化组术前肝组织血流量为18.0，术后为15.6，14.1，9.3。阻断组术前肝组织血流量为15.6，术后分别为15.8，15.8，12.2。[讨论]假设术前水平为100%，动脉化组门静脉血氧分压和门静脉血流量的变化率明显高于闭塞组(P<0.05)。这些结果表明，肝动脉-门静脉分流术可以在肝动脉阻断后维持肝脏的血流量和氧气供应，有助于预防肝功能衰竭。较少

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