采用1,6-二磷酸果糖常温灌注对全肝血管阻断原位扩大肝切除术中肝功能的维持作用。

Effect of normothermic perfusion using fructose-1,6-bisphosphate for maintenance of liver function during in situ extended hepatectomy by the total hepatic vascular exclusion technique.

作者信息

Uemura Ryuichiro, Uchiyama Kazuhisa, Ozawa Satoru, Yamaue Hiroki

机构信息

Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan.

出版信息

J Surg Res. 2007 Jan;137(1):89-95. doi: 10.1016/j.jss.2006.07.029. Epub 2006 Nov 2.

DOI:10.1016/j.jss.2006.07.029

PMID:17084408

Abstract

BACKGROUND

Recently, hepatic surgery has made remarkable progress, and it is important to use appropriate liver perfusion. We evaluated the effect of normothermic liver perfusion with the addition of fructose-1, 6-bisphosphate (FBP) and oxygenation to maintain liver parenchymal, non-parenchymal, and Kupffer cell function.

MATERIALS AND METHODS

The rats were divided into five groups according to the perfusate and continuous perfusion was performed: Control group = 4 degrees C lactate Ringer with 10% glucose (LRG) solution; normothermic group = 25 degrees C LRG solution; normothermic oxygenated group = 25 degrees C oxygenated LRG solution; normothermic FBP group = 25 degrees C LRG solution with addition of 10 mmol/L FBP; normothermic oxygenated FBP group = 25 degrees C oxygenated LRG solution with addition of 10 mmol/L FBP. Parameters under evaluation were oxygen consumption, liver energy level (adenosine triphosphate, total adenine nucleotide), glutathione, lipid peroxide, hyaluronic acid uptake ratio, apoptosis, and histomorphology. Moreover, we studied the effect of FBP and normothermia on Kupffer cells activation in vitro.

RESULTS

Liver energy level was lower in the normothermic group than the control group. But, it was improved by oxidation or addition of FBP, and it was satisfactorily maintained up to 120 min in the group with normothermic oxygenated FBP. Hyaluronic acid uptake was maintained highly at all times as measured in normothermic oxygenated FBP group. The uptake of lipopolysaccharide was significantly higher as a result of adding FBP, compared with that in the control group and the normothermic group. Moreover, the apoptotic index in the liver was decreased in normothermic FBP group compared to control group.

CONCLUSIONS

The normothermic liver perfusion under additional FBP and oxygenation protects both parenchymal and non-parenchymal cells from reperfusion injury.

摘要

背景

近年来，肝脏手术取得了显著进展，采用合适的肝脏灌注方法很重要。我们评估了添加1,6 -二磷酸果糖（FBP）和氧合进行常温肝脏灌注对维持肝实质细胞、非实质细胞和库普弗细胞功能的影响。

材料与方法

根据灌注液将大鼠分为五组并进行持续灌注：对照组=含10%葡萄糖的4℃乳酸林格氏液（LRG）；常温组=25℃ LRG溶液；常温氧合组=25℃氧合LRG溶液；常温FBP组=添加10 mmol/L FBP的25℃ LRG溶液；常温氧合FBP组=添加10 mmol/L FBP的25℃氧合LRG溶液。评估的参数包括氧消耗、肝脏能量水平（三磷酸腺苷、总腺嘌呤核苷酸）、谷胱甘肽、脂质过氧化物、透明质酸摄取率、细胞凋亡和组织形态学。此外，我们研究了FBP和常温对体外库普弗细胞活化的影响。