| It used to be the advanced stage with the hepatic artery and hepatic tissure encroached when klatskin tumour was operated . With the purpose of radical operation , it has to be operated extended when necessary, including hepatectomy and hepatic arteriectomy . Patients with klaskin tumour often had obstructive jaundice and hepatic function lesion, and it is tendency to occur ischemia and anoxia when hepatic arterectomy was taken, and lead to liver failure finally ,a severe postoperation complication.The arterialization of portal vein was brought forward for the decreased hepatic blood supply after shunt of portal vein to vena cava by Cohn in 1952, he thought ,the total blood stream of liver decreased largely . The increased amount of hepatic artery blood regulatory is not enough to meet the deficiency of portal vein perfusion .The hepatic arterial blood stream could not maintain the pressure and perfusion of hepatic blood sinusoid , in function ,it can't substitute the portal blood . He conceived to perfuse portal vein with arterial blood to compensation the absence of portal blood . Iseki reported 1992, to rise the partial pressure of oxygen of portal vein blood with demi-arterialization of portal vein . Oeeki Y reported a method of partial arterialization of portal vein with ileo-colon arteriovenous anastomosis in 1997, he thought this can prevent the liver failure caused by embolism of hepatic artery after liver operation . But overdose of artery flow perfusion into 'portal vein could bring liver harmful result. It will become a safe and effective operation only when suitable dose ofartery blood stream was perfused into portal vein .Methods:According to the characteristic of klatskin tumour , for the largest protect of liver and achieve radical operation , how can we take adervantage of arterialization of portal vein to reduce the complications of the operation? For verification this problem , we design three rat model to imitate the pathology characteristic of klaskin tumour: 1. hepatocirrhosis. 2. Obstructive jaundice. 3. partial hepatectomy. With three rat model , we perform three different operations : 1. Matched control group . 2.Hepatic artery ligation group. 3. Partial arterialization of portal vein after hepatic artery ligation group. After operation, we observed and detected series target in different time , such as : 1.hepatic function. 2.tissure structure. 3. the blood flow and pressure of portal vein . 4. microcirculation of hepatic tissue by laser Doppler . 5. apoptosis of hepatic cell .6. DNA Ladder .7. Na+-K+ATP enzyme activity of hepatic cell membrane . The experiment data was treated by statistics analysis with stataT.O.ResultsThe hepatic function of hepatic artery ligation group is obviously disorder. Ischemia and anoxia, necrosis was observed with microscope .The swelling of cell organelles, lysis of nuclear membrane was found with electron microscope , and the normall structure of organelles disapper .The blood flow of portal vein was heighten , but the microcirculation index was decreased . The cell apoptosis rate of hepatic artery ligation group was high , with typical DNA Ladder. The activity of Na+-K+ATP enzyme was low compared with control group.The manifestation of arterialization group is better than that of arteryligation group , similar to control group, the significance of statistic test is notable.ConclusionsLigation or resection of hepatic artery might bring great lesion on liver when klatskin tumour was accompanied with obstructive jaundice and hepatocirrhosis. The absent supply of hepatic artery blood make aerobic metabolism obstacle, make function and structure severe disorder, lead to hepatic necrosis and liver failure. But if the partial arterialization of portal vein was performed after artery ligation, perfusing artery blood into portal vein, the lesion may reduced significantly, almost normally. Partial arterialization of portal vein make it possible to reduce the severe complication when radical operation was performed with arte... |
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