Schweizer W, Duda P, Tanner S, Balsiger D, Höflin F, Zimmermann A, Blumgart L H
Universitätsklinik für viszerale und Transplantationschirurgie, Universität Bern, Inselspital Bern.
Helv Chir Acta. 1992 Aug;59(2):389-98.
Patients with lobar or segmental, benign or malignant strictures of the biliary tree (with or without impairment of the portal blood flow) show a considerable atrophy of the involved area of the liver with a compensatory hypertrophy/hyperplasia of the remaining non affected liver. To investigate the importance of the biliary and portal obstruction for the development of this process, we used a rat model, with selective biliary and/or portal ligation of the anterior liver lobes (two thirds of the liver mass). Weight measurements, morphometry, functional scintigraphy (Hepatoiodida-scan) and blood enzyme analyses were done immediately postoperatively, at 30 hours and 4, 8 and 28 days after the operation. The major findings were: 1. 28 days after biliary and/or portal ligation there was no difference between the body weight of the four groups, all ligated animals having compensated for an initial greater percentage body-weight loss. 2. Total liver weight remained constant, while atrophy and hypertrophy/hyperplasia occurred although a progressive derangement of liver morphology was observed during that time. 3. A severe atrophy-hypertrophy-complex (AHC) developed after selective portal ligation, which in our experiment did not appear after selective biliary ligation. 4. Morphometrical changes after selective biliary ligation were reversible, whereas in liver lobes with selective portal ligation a progressive parenchymal destruction and involution with subsequent impairment of hepatic function of the concerned lobe was observed.
患有肝叶或节段性、良性或恶性胆管狭窄(伴或不伴有门静脉血流受损)的患者,其肝脏受累区域会出现相当程度的萎缩,而其余未受影响的肝脏会出现代偿性肥大/增生。为了研究胆管和门静脉梗阻在这一过程发展中的重要性,我们使用了大鼠模型,对肝脏前叶(肝脏质量的三分之二)进行选择性胆管和/或门静脉结扎。在术后即刻、术后30小时以及术后4天、8天和28天进行体重测量、形态计量学分析、功能性闪烁扫描(肝碘扫描)和血液酶分析。主要发现如下:1. 胆管和/或门静脉结扎28天后,四组动物的体重没有差异,所有结扎动物都弥补了最初较大比例的体重减轻。2. 肝脏总重量保持恒定,尽管在此期间观察到肝脏形态逐渐紊乱,但萎缩和肥大/增生仍会发生。3. 选择性门静脉结扎后出现严重的萎缩-肥大复合体(AHC),而在我们的实验中,选择性胆管结扎后未出现这种情况。4. 选择性胆管结扎后的形态计量学变化是可逆的,而在选择性门静脉结扎的肝叶中,观察到实质逐渐破坏和退化,随后相关肝叶的肝功能受损。