Effects of liver denervation on hepatic microcirculation

肝动脉血栓形成是接受肝移植或肝切除联合肝动脉重建的患者的灾难性事件。挽救肝脏的唯一希望是及时手术切除和修复，但其预后仍不充满希望。最近，在十二指肠溃疡穿孔的情况下，在腹腔镜下进行了大网膜补片修补术，为大网膜损伤的病变提供了血管来源。本实验采用Wistar大鼠(体重200~220g)，采用结扎大动脉的方法，观察大网膜种植后新生血管的形成情况。A组为单纯剖腹手术组，B组为肝动脉结扎组，C组为肝动脉结扎组，D组为非肝动脉结扎组。分别于术后1、3、7、30、90d处死动物，行血管造影、激光多普勒法测定肝组织血流量、彩色微球法测定肝动脉血流量及CD34免疫组织化学染色。结果肝组织血流量(LTB)由HAL后的27.5±5.5ml/min/100g降至23.5×4.5，而肝组织血流量无明显增加。经CMS检测，C组移植肝各时相点的肝动脉血流量均显著高于B组。术后7d以上，切取肝脏的血管造影和光镜观察显示，大网膜植入周围有明显的血管生成。结论HALL大鼠肝脏OI后可观察到新生血管的形成，OI有助于预防肝动脉血栓形成后的器官缺氧。

Hepatic artery thrombosis is a catastrophic event in patients who have undergone Liver transplantation or hepatic resection in combination with reconstruction of the hepatic artery. The only hope for salvation of the liver is prompt surgical intervention with declotting and repair, but its prognosis is still not full of hope. Recently, laparoscopic omental patch repair has been performed in the perforated duodenal ulcer, precipitating a vascular source for the injured lesion by the omentum. We performed an experimental study to evaluate the formation of new blood-vessels after omental implantation (OI) in rats with ligation of the heatic artery.Material and Methods Wistar rats (200-220g) were used for the study and divided into the following groups. Groups A : simple laparotomy as control, B : hepatic artery ligation (HAL), C : OI with HAL, D : OI without HAL.For angiography, measurements of liver tissue blood flow by Laser Doppler method, and hepatic artery flow by colored-microsphere method (CMS), and immunohistochemical study for CD34, the animals were sacrificed at 1, 3, 7, 30, 90 days after the laparotomy.Results Liver tissue blood flow (LTB) decreased significantly from 27.5*5.5 ml/min/100g to 23.5*4.5 after HAL but no siginificant increase in LTB was seen after OI.However, hepatic artery blood flow assessed by CMS in the implanted lobe of group C showed siginificantly higher levels at various times than those of group B.Angiography and microscopic studies in the excised liver revealed distinct angiogenesis around omental implantation over 7 days postoperatively.Conclusion The formation of new blood-vessels after OI was observed in rat livers with HAL.OI would be useful in the prevention of organ anoxia after hepatic artery thrombosis.