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目的利用人工血管行肠系膜上静脉与肝下下腔静脉搭桥建立暂时性肠腔分流动物模型,初步摸索肠腔分流条件下猪单纯门静脉阻断的安全时限。方法将14头正常巴马小型猪分为A组(门静脉阻断120 min)、B组(门静脉阻断150 min),(n=7)。两组动物在全麻插管呼吸机辅助呼吸的条件下用人造血管在肠系膜上静脉、肝下下腔静脉间架桥,建立临时性肠腔分流模型,按分组阻断门静脉。对照观察两组动物在阻断前、复流前、复流后2h及术后1、3、5d的ALT、AST、TBIL及肝组织病理变化情况。结果①整个阻断门静脉的过程中,各组动物肠管未见明显淤血,颜色基本正常,证实采用人工血管在肠系膜上静脉与肝下下腔静脉间架桥行暂时性门腔分流有效。②A组动物长期存活率为100%,B组长期存活率为57.1%,两组动物存活率有显著差异(P<0.05)。③在复流前、复流2h、术后1 d各相同时相点,B组动物的ALT、AST、TBIL组较A组明显升高(P<0.05)。④A组门静脉阻断120min,汇管区炎细胞浸润;复流2 h后,病变进一步加重,肝细胞出现变性,灶性坏死,肝窦充血,汇管区及肝窦内明显炎细胞浸润。B组门静脉阻断150min肝见汇管区大量出血,白细胞聚集,细胞广泛空泡样变,肝组织灶性坏死;复流2 h后,进一步加重,肝细胞广泛气球样变、脂肪变性,内皮细胞肿胀、水肿明显,肝窦广泛充血,汇管区及肝窦大量炎性细胞浸润,B组较A组损伤更为显著,两组有显著性差异。电镜下B组较A组线粒体水肿,内质网扩张扩张更为明显,且出现细胞核高度浓缩,纤维沉积等不可逆损伤。结论在肠腔分流条件下,避免肠道淤血,正常巴马小型猪耐受单纯门静脉阻断安全时限为120min。
Objective To establish a temporary animal model of intestinal shunts by using the superior mesenteric vein and inferior hepatic vena cava bypass graft with artificial blood vessels and to explore the safe time limit of simple portal vein occlusion of pigs under intestinal shunt. Methods 14 normal Bama miniature pigs were divided into group A (portal vein occlusion 120 min) and group B (portal vein occlusion 150 min) (n = 7). Two groups of animals under general anesthesia intubation ventilator assisted breathing with artificial blood vessels in the superior mesenteric vein, subhepatic inferior vena cava bridge, the establishment of a temporary intestinal shunt model, according to the group blocking the portal vein. The changes of ALT, AST, TBIL and pathological changes of liver in two groups were observed before occlusion, before reperfusion, 2 hours after reperfusion, and 1,3,5 days after reperfusion. Results ① In the process of blocking the portal vein, there was no obvious congestion in the intestine of each group and the color was basically normal. It was confirmed that the temporary portal shunt was effective in bridging the superior mesenteric vein and inferior hepatic vena cava with artificial blood vessels. ② The long-term survival rate of group A was 100%, while the long-term survival rate of group B was 57.1%. There was significant difference between the two groups (P <0.05). (3) The ALT, AST and TBIL in group B were significantly higher than those in group A (P <0.05) at 2 h after reperfusion and 2 h after reperfusion and 1 d after operation respectively. ④A group of portal vein occlusion 120min, portal area inflammatory cell infiltration; 2 h after reflow, the lesions further aggravated, degeneration of hepatocytes, focal necrosis, sinusoidal congestion, portal area and hepatic sinusoidal inflammatory cell infiltration. B group of portal vein occlusion 150min hepatic portal area massive hemorrhage, leukocyte accumulation, cell vacuolar degeneration, focal necrosis of liver tissue; 2 h after reflow, further aggravating, extensive hepatocellular balloon, steatosis, endothelial cells Swelling, edema, hepatic sinusoid hyperemia, portal area and hepatic sinusitis a large number of inflammatory cell infiltration, B group was more significant than A group of injury, the two groups were significantly different. Electron microscope group B compared with group A mitochondria edema, endoplasmic reticulum dilatation and more obvious, and the emergence of highly concentrated nuclei, fiber deposition and other irreversible damage. Conclusions In the case of shunting of the intestine, intestinal congestion is avoided, and the safety limit of simple portal vein occlusion in normal Bama miniature pigs is 120min.