Höckerstedt K, Ahonen J, Nieminen J, Scheinin T M
Ann Chir Gynaecol. 1978;67(6):229-35.
Dearterializaton of the liver causes changes which have been thought to be ischaemic in nature. Previous reports of direct measurements of liver tissue gas tensions have been confined only to the acute postoperative phase. In this study 15 dogs underwent a standardized and angiographically controlled liver hilus dearterialization with (6 dogs) or without (9 dogs) cholecystectomy. Six dogs underwent a sham operation and were used as controls. Liver respiratory gas tensions were measured with a Silastic tonometer intraoperatively during the first 90 minutes after dearterialization and on the first and seventh day postoperatively. Six dogs died, only one of these being in the dearterialization and cholecystectomy group. Liver pO2 decreased from the mean of 33.2 mmHg to a level of 15--20 mmHg in 20 minutes (p less than 0.05) during room air breathing. On the next day the liver pO2 values were normal. There was no difference in pO2-Values between the cholecystectomy and the noncholecystectomy groups. Liver pCO2 increased from the mean of 26.4 mmHg to 55--60 mmHg in the same time (p less than 0.05). However, on the first postoperative day normal values were seen only in the cholecystectomy group. 60% oxygen breathing prevented the changes in both liver pO2 and pCO2. No changes were noted in the liver gas tensions of the sham-operated dogs, not in the systemic arterial pO2 and pCO2 of the dearterialized animals. Thus a transient hypoxic state developed after this operation, which lasted for less than one day. This hypoxia may be prevented by 60% oxygen breathing postoperatively.
肝脏去动脉化会引发一些被认为本质上是缺血性的变化。先前关于肝脏组织气体张力直接测量的报告仅局限于术后急性期。在本研究中,15只狗接受了标准化且经血管造影控制的肝门去动脉化手术,其中6只狗同时进行了胆囊切除术,9只狗未进行胆囊切除术。6只狗接受了假手术并作为对照。在去动脉化后的前90分钟内以及术后第一天和第七天,术中使用硅橡胶张力计测量肝脏呼吸气体张力。6只狗死亡,其中仅1只在去动脉化和胆囊切除组。在呼吸空气时,肝脏pO2在20分钟内从平均33.2 mmHg降至15 - 20 mmHg水平(p < 0.05)。第二天肝脏pO2值恢复正常。胆囊切除组和非胆囊切除组之间的pO2值没有差异。同时肝脏pCO2从平均26.4 mmHg升至55 - 60 mmHg(p < 0.05)。然而,仅在胆囊切除组术后第一天观察到正常数值。吸入60%氧气可防止肝脏pO2和pCO2的变化。假手术狗的肝脏气体张力没有变化,去动脉化动物的体动脉pO2和pCO2也没有变化。因此,该手术后出现了短暂的低氧状态,持续时间不到一天。术后吸入60%氧气可预防这种低氧状态。