门脉高压论文：胃去门静脉循环断流术对肝前型门静脉高压犬胃粘膜及微循环血管超微结构的影响.doc

门脉高压论文：胃去门静脉循环断流术对肝前型门静脉高压犬胃粘膜及微循环血管超微结构的影响【中文摘要】观察胃去门静脉循环断流术对肝前型门静脉高压犬胃粘膜及粘膜下微循环血管超微结构的影响。方法12只成年杂种犬按照“李宗芳法”(门静脉缩窄一半,丝线引起门静脉慢性血栓形成)制作犬肝前型门静脉高压食管静脉曲张模型,并于建模后4周,造影检查侧支循环及曲张静脉形成情况。成模后随机分为2组,分别行贲门周围血管离断术(pericardial devascularization, PCDV)和胃去门静脉循环断流术(de-splanchnic circulation of stomach, DSCS),分别于开腹后、手术后即刻及术后4周末测量门静脉及食管曲张静脉压力。手术前、手术后4周末测定肝功能指标。术后4周末取胃组织进行透射电镜观察。结果1.DSCS组门静脉压力由术前的23.640.40cmH2O降至术后4周的20.620.97cmH2O,差异有统计学意义(P0.01)；食管曲张静脉压力由术前的22.140.93cmH2O降至术后4周的17.840.36cmH2O,差异有统计学意义(P0.05)。3.超微结构显示贲门周围血管离断术组胃粘膜上皮细胞微绒毛断裂、脱落,微绒毛明显减少,粘膜下微静脉内皮细胞基膜厚薄不均且不连续,内皮细胞间隙可见明显红细胞聚集。而DSCS组胃粘膜上皮细胞微绒毛排列较整齐,断裂少见,粘膜下微静脉内皮细胞未见明显异常。结论DSCS手术可降低肝前型门静脉高压犬的门静脉及食管曲张静脉压力,同时能改善胃粘膜及粘膜下微循环血管超微结构。【英文摘要】To evaluate the influence of de-splanchnic circulation of stomach (DSCS) on ultramicrostructure of gastric mucosa and submucosal microcirculation in prehepatic portal hypertensive canine models.Methods We established prehepatic portal hypertensive canine models by half constriction and silk line chronic embolization of portal vein. The esophageal varices and collateral circulation were observed by venography after 4 weeks of modeling. The formed canine models were divided into pericardial devascularization (PCDV) group (PCDV) and DSCS group randomly.We measured the portal venous pressure (PVP) and esophageal variceal pressure (EVP) respectively by puncturing superior mesenteric vein and pericardial varices before surgery, immediately after surgery and 4 weeks after surgery. We also tested the liver function preoperatively and 4 weeks after surgery. The ultrastructure was observed by transmission electron microscopy 4 weeks postoperatively.Results 1. The PVP was decreased significantly from 23.640.40cmH2O to 20.620.97cmH2O after DSCS (P0.01). The EVP was decreased significantly from 22.140.93cmH2O to 17.840.36cmH2O after DSCS (P0.05).3. The gastric mucosal lesions in DSCS group were lighter than that in PCDV group 4 weeks after surgery. Ultrastructure showed that the microvillus of gastric epithelium cells were interrupted and fell off and that microvillus significantly reduced. Moreover, it was also shown that the basal lamina of submucosal veinule endothelial cells were uneven thick and discontinuous and that red blood cells could be obviously gathered in the endothelial cells interspace in pericardial devascularization group. There were less damages in the gastric musosa epithelia and submucosal venule endothelial cells in DSCS group.Conclusion DSCS can distinctly reduce the portal venous pressure and esophageal varicose vein pressure and improve the ultramicrostructure of gastric mucosa and submucosal microcirculation in canine models with prehepatic portal hypertension.【关键词】门脉高压 血液动力学 动物模型 外科治疗 超微结构【备注】索购全文在线加好友：1.3 99.3.8848 同时提供论文一对一写作指导和论文发表委托服务【英文关键词】Portal hypertension Hemodynamics Animal Models Surgical Procedures Ultramicrostructure【目录】胃去门静脉循环断流术对肝前型门静脉高压犬胃粘膜及微循环血管超微结构的影响摘要2-3Abstract3引言5-6第一章 资料和方法6-111.1 研究对象61.2 模型制备6-71.3 手术方法7-81.4 术后观察指标及方法8-91.5 统计学处理