Sakaguchi T, Nakamura S, Suzuki S, Baba S, Nakashima M
Second Department of Surgery, Department of Pharmacology, Hamamatsu University School of Medicine, Japan.
Eur Surg Res. 1996;28(5):341-50. doi: 10.1159/000129475.
Portal vein (PV) stenosis may contribute to operative death after extended hepatectomy combined with PV reconstruction leading to impairment of the intestinal mucosal barrier. This study was designed to investigate whether rats undergoing such surgery developed endogenous endotoxemia and increased intestinal permeability. The effect of a prostaglandin I2 (PGI2) analogue on mucosal barrier function was also studied. The rats were divided into the following five groups: sham operation, massive hepatectomy (Ht), PV stenosis (PS), combined Ht and PS (Ht+PS), and Ht+PS with subcutaneous injection of PGI2 preoperatively (PG). The 10-day survival rate, portal endotoxin level and intestinal permeability (two-sugar test) were evaluated in each group. The Ht+PS group showed a significant increase in both the portal endotoxin level and intestinal permeability (p < 0.05) and a significant worse 10-day survival (p < 0.01) than the other four groups. PGI2 pretreatment did not influence splanchnic blood flow, but decreased the endotoxin level and reduced intestinal permeability. In conclusion, the synergistic effect of massive hepatectomy and PV stenosis induced an increased intestinal permeability and consequently endotoxemia. PGI2 pretreatment significantly improved both intestinal barrier function and survival.
门静脉（PV）狭窄可能导致扩大肝切除联合PV重建术后的手术死亡，进而损害肠黏膜屏障。本研究旨在调查接受此类手术的大鼠是否会发生内源性内毒素血症并增加肠道通透性。同时还研究了前列腺素I2（PGI2）类似物对黏膜屏障功能的影响。将大鼠分为以下五组：假手术组、大规模肝切除组（Ht）、PV狭窄组（PS）、联合Ht和PS组（Ht+PS）以及术前皮下注射PGI2的Ht+PS组（PG）。评估每组的10天生存率、门静脉内毒素水平和肠道通透性（双糖试验）。与其他四组相比，Ht+PS组的门静脉内毒素水平和肠道通透性均显著升高（p<0.05），10天生存率显著降低（p<0.01）。PGI2预处理不影响内脏血流，但可降低内毒素水平并降低肠道通透性。总之，大规模肝切除和PV狭窄的协同作用导致肠道通透性增加，进而引发内毒素血症。PGI2预处理显著改善了肠道屏障功能和生存率。
