Zhao Hong-Feng, Zhang Guo-Wei, Zhou Jie, Lin Jian-Hua, Cui Zhong-Lin, Li Xiang-Hong
Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Hepatobiliary Pancreat Dis Int. 2009 Jun;8(3):247-54.
There is a controversy over the degree of liver and biliary injury caused by the period of secondary warm ischemia. A liver autotransplantation model was adopted because it excludes the effects of infection and immunological rejection on bile duct injury. This study was undertaken to assess biliary tract injury caused by relative warm ischemia (secondary warm ischemia time in the biliary tract) and reperfusion.
One hundred and two rats were randomly divided into 5 groups: group I (control); groups II to V, relative warm ischemia times of 0 minute, 30 minutes, 1 hour and 2 hours. In addition to the levels of serum alkaline phosphatase, and total bilirubin, pathomorphology assessment and TUNEL assay were performed to evaluate biliary tract damage.
Under the conditions that there were no significant differences in warm ischemia time, cold perfusion time and anhepatic phase, group comparisons showed statistically significant differences. The least injury occurred in group II (portal vein and hepatic artery reperfused simultaneously) but the most severe injury occurred in group V (biliary tract relative warm ischemia time 2 hours).
Relative warm ischemia is one of the factors that result in bile duct injury, and the relationship between relative warm ischemia time the bile injury degree is time-dependent. Simultaneous arterial and portal reperfusion is the best choice to avoid the bile duct injury caused by relative warm ischemia.
继发性热缺血期所致肝和胆道损伤的程度存在争议。采用肝脏自体移植模型是因为它排除了感染和免疫排斥对胆管损伤的影响。本研究旨在评估相对热缺血（胆道继发性热缺血时间）和再灌注引起的胆道损伤。
102只大鼠随机分为5组：I组（对照组）；II至V组，相对热缺血时间分别为0分钟、30分钟、1小时和2小时。除检测血清碱性磷酸酶和总胆红素水平外，还进行病理形态学评估和TUNEL检测以评价胆道损伤。
在热缺血时间、冷灌注时间和无肝期无显著差异的情况下，组间比较显示出统计学显著差异。II组（门静脉和肝动脉同时再灌注）损伤最小，而V组（胆道相对热缺血时间2小时）损伤最严重。
相对热缺血是导致胆管损伤的因素之一，相对热缺血时间与胆汁损伤程度之间的关系呈时间依赖性。动脉和门静脉同时再灌注是避免相对热缺血所致胆管损伤的最佳选择。
