中国医科大学学报

中国医科大学学报

中国医科大学学报 ›› 2010, Vol. 39 ›› Issue (2): 108–.

• 基础医学 • 上一篇    下一篇

脾切除在防治小肝综合征中的作用

吴刚; 孙会东; 杨蕾; 陈旭春; 程颖; 刘永锋   

  1. 中国医科大学附属第一医院肝胆外科; 山东省聊城市人民医院普外科
  • 出版日期:2010-02-27 发布日期:2013-06-07
  • 通讯作者: 刘永锋 E-mail:yfliu@mail.cmu.edu.cn

The Role of Splenectomy in the Prevention and Treatment of Small-for-size Syndrome

  • Online:2010-02-27 Published:2013-06-07

摘要:

目的探讨小肝综合征发生的内在机制及脾切除对小肝综合征发生的影响。方法建立大鼠小体积肝脏模型。脾切除组切除80%肝组织同时行脾切除,对照组仅行80%肝组织切除,假手术组仅肝脏游离,不做肝切除。检测术后门静脉压力、肝组织肿瘤坏死因子α(TNF-α)和增殖细胞核抗原(PCNA)mRNA和蛋白表达及髓过氧化物酶(MPO)活性、肝功能变化及小肝综合征发生率。结果肝切除后,对照组和假手术组比较门静脉压力明显增高,TNF-αmRNA表达和蛋白表达明显增强,MPO活性明显增高(P<0.05);脾切除组和对照组比较门静脉压力降低,TNF-αmRNA和蛋白表达量、MPO活性均降低(P<0.05),而PCNAmRNA和蛋白表达明显增强(P<0.05)。脾切除组肝功能损害及小肝综合征的发生率和对照组比较显著降低(P<0.05)。结论脾切除能够降低小体积肝脏的门静脉灌流和压力,减少促炎性细胞因子的表达和释放,减轻细胞损害,促进肝再生,降低小肝综合征的发生。

关键词: 肝切除, 肝移植, 小肝综合征, 脾切除, 肝切除, 肝移植, 小肝综合征, 脾切除

Abstract:

Objective To explore the pathophysiologic mechanism of the
      development of a small-for-size syndrome(SFSS)and the role of splenectomy
      in the prevention and treatment of SFSS.Methods The rat models of
      sham-operation and 80% partial hepatectomy were established.Totally 144
      rats were randomly divided into 3 groups:1) splenectomy group:splenectomy
      was performed following 80% partial hepatectomy;2)control group:80%
      partial hepatectomy was performed;3)sham group:no hepatectomy was
      performed.After the operation, we examined the portal venous
      pressures(PVP),tumor necrosis factor(TNF-α)and proliferating cell nuclear
      antigen(PCNA)expression, the activity of myeloperoxidase(MPO),liver
      function and explored the prevalence of SFSS.Results Compared with the
      sham group,the PVP of the rats in the control group obviously elevated
      after hepatectomy,and the expression level of TNF-α and the activity of
      MPO in the liver significantly increased(P < 0.05).Compared with the
      control group,the PVP,the expression of TNF-α in the livers and the
      activity of MPO at the corresponding time points after hepatectomy in the
      splenectomy group significantly decreased,while the expression of PCNA
      increased(P < 0.05).Administration of splenectomy resulted in a
      statistically significant decrease in aspartate transaminase(AST),alanine
      transaminase(ALT),lactate dehydrogenase(LDH),total bilirubin,and the
      incidence of SFSS(P < 0.05).Conclusion Splenectomy could alleviate liver
      injury,promote liver regeneration in small-for-size liver rats by reducing
      portal vein perfusion and pressure and the subsequent expression of
      proinflammatory mediators.

Key words: hepatectomy, liver transplantation, small-for-size syndrome; splenectomy, hepatectomy, liver transplantation, small-for-size syndrome(SFSS), splenectomy

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