Iizuka I
Second Department of Surgery, University of Tokyo, Japan.
Nihon Geka Gakkai Zasshi. 1989 May;90(5):712-20.
The influence of division of the common hepatic artery (CHA) was studied using dogs, by measuring the blood flow of the proper hepatic artery (PHA) by an electromagnetic flowmeter, and tissue blood flow of the liver and the gallbladder by the H2 gas clearance method. The results expressed as relative values (value before the division of CHA = 1.0) were as follows. 1) PHA blood flow decreased to 0.40 +/- 0.18 (n = 14) after the division of CHA. 2) After the division of CHA, tissue blood flow of the liver decreased to 0.61 +/- 0.16 (n = 27), and tissue blood flow of the gallbladder, to 0.51 +/- 0.16 (n = 40). After additional occlusion of the gastroduodenal artery, these values were 0.51 +/- 0.16 and 0.23 +/- 0.13, respectively. 3) On the seventh day after CHA division, tissue blood flow of the gallbladder recovered to 0.84 +/- 0.50. 4) Necrosis of the gallbladder, which was mostly partial was found in 20% of the experimental dogs at autopsy. These results showed that there is effective arterial collateral circulation after division of the CHA, which makes Appleby's operation practicable. However, considering the degree of ischemia observed in the gallbladder, preservation of collaterals during Appleby's operation will be essential for the prevention of necrosis of the gallbladder.
利用狗研究了肝总动脉（CHA）分支的影响，通过电磁流量计测量肝固有动脉（PHA）的血流，并采用氢气清除法测量肝脏和胆囊的组织血流。以相对值表示的结果（CHA分支前的值 = 1.0）如下：1）CHA分支后，PHA血流降至0.40±0.18（n = 14）。2）CHA分支后，肝脏的组织血流降至0.61±0.16（n = 27），胆囊的组织血流降至0.51±0.16（n = 40）。在额外结扎胃十二指肠动脉后，这些值分别为0.51±0.16和0.23±0.13。3）CHA分支后第7天，胆囊的组织血流恢复至0.84±0.50。4）尸检时在20%的实验狗中发现胆囊坏死，大多为部分坏死。这些结果表明，CHA分支后存在有效的动脉侧支循环，这使得阿普尔比手术可行。然而，考虑到胆囊中观察到的缺血程度，在阿普尔比手术期间保留侧支对于预防胆囊坏死至关重要。
