胆管周围血管丛在移植肝胆道热缺血再灌注损伤与修复中的作用
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朱晓峰

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The roles of peribiliary vascular plexus on regeneration of intrahepatic bile ducts after warm ischemia-reperfusion injury of transplanted liver
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    摘要:

    目的:探讨热缺血再灌注损伤后胆管周围血管丛在胆道损伤与修复中的作用,及胆道易受热缺血再灌注损伤的可能机制。
    方法:雄性SD大鼠,随机分为3组:假手术组(S组); 无热缺血组(W0组); 10 min热缺血组(W 0组)。分别在冷保存后(即0 h)及移植肝再灌注后6,24 h,3,7,14,30 d获取标本。每个时间点6只。检测各组血中ALT,GGT,TBIL。并取肝组织行连续切片,分别利用CK19和第八因子相关抗原标记胆管上皮细胞和血管,计数每个汇管区胆管、血管、伴有血管的胆管、不伴有血管的胆管以及孤立的血管数。
    结果:W10组GGT,TBIL比W0组GGT,TBIL高于S组的时间更长,且ALT恢复至S组水平较GGT,TBIL更早、更快。W10组汇管区炎症细胞浸润程度、胆管结构破坏程度、汇管区纤维化,比W0组及S组更严重。电镜下可见,W10组胆管周围血管丛内微血栓形成。肝移植术后6,24 h,W10组移植肝汇管区血管数量较W0组及S组明显减少。虽然术后24 h胆管即开始明显增生,但直到术后14~30 d,W10组血管数及伴有血管的胆管数才较W0组及S组增多。
    结论:移植肝热缺血再灌注损伤可致胆管周围血管丛微血栓形成,引起血管内皮细胞损伤加重,导致胆管微循环障碍,以及胆管周围血管丛再生明显滞后于胆管再生,这些可能是胆管易受热缺血再灌注损伤的重要原因。

    Abstract:

    Objective:To explore the roles of peribiliary vascular plexus(PBP) on regeneration of intrahepatic bile ducts after warm ischemia-reperfusion injury and the possible meshanism of PBP on bile ducts sensitive to warm ischemia-reperfusion injury of transplanted liver.
    Methods :Male SD rats were used in this experiment. The animals were divided into three groups: shame operation group(S group), warm ischemia of grafts for 0 min group (W0 group),and warm ischemia of grafts for 10 min group (W10 group). Seven time points were determined as 0 h,6,24 h,and 3,7,14,30 d post-reperfusion. Six animals were used per time-point. ALT, GGT, and TBIL of serum were determined.Serial liver sections were made and were immunolocalized by CK19 and FⅧ-R Ag to assess the co-localization of bile ducts and microvessels. Bile ducts were identified by CK19 and microvessels were identified by FⅧ-R Ag.
    Results:In W10 group, the level of plasma GGT and total bilirubin was elevated with a increase longer than in W0 group. The portal inflammation, damage of bile ducts,and fibrosis area of portal area of W10 group were significantly more seriously than those in W0 and S groups. Under electron microscope, micro-thrombosis in microvessels were observed in W10 group. Furthermore, in W10 group, the number of intraportal microvessels at 6h and 24 h post-reperfusion was markedly decreased compared to that of W0 and S groups. In W10 group, although cholangiocytes showed significant regeneration at 24 h post-reperfusion, the number of intraportal microvessels and bile ducts with accompanying microvessels was not higher than that of W0 and S groups at 14 to 30 days after reperfusion.
    Conclusions:Warm ischemia-reperfusion injury of liver grafts can cause microthrombosis of peribilary vascular plexus and induce increased damage of vascular endothelial cells and the later can cause disturbance of microcirculation of bile ducts and delayed regcneration of bile ducts.These changes may be important causes of vulnerability of bile ducts to warm ischemia-reperfusion injury.

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孙强, 余元龙, 胡泽民, 陈宏, 吴爱国, 朱晓峰.胆管周围血管丛在移植肝胆道热缺血再灌注损伤与修复中的作用[J].中国普通外科杂志,2009,18(2):9-.
DOI:10.7659/j. issn.1005-6947.2009.02.009

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  • 在线发布日期: 2009-02-25