摘要
目的应用超声造影(CEUS)定量分析大鼠70%肝部分切除(PH)后不同类型门静脉狭窄(PVS)残肝微循环灌注变化。方法将75只SD大鼠随机分为PH组(15只)和PH后中、重度PVS(PVS_(M)、PVSS)组(各30只)。PVS组根据狭窄部位不同分为肝门组和非肝门组(各15只)。各组按术后不同大鼠处死时间(1 d、2 d、3 d、7 d、14 d)分为5个亚组,每组各3只。PH组行70%PH;PVS组在PH组处理基础上于门静脉不同部位行不同程度部分结扎。于术后1、2、3、7、14 d行CEUS检查,对残余肝右侧叶及乳头叶微循环灌注进行定量分析,获取始增时间(AT)、达峰时间(TP)、峰值强度(PI)和曲线下面积(AUC)。采用单因素方差分析法对PH组、PVS_(M)组、PVSS组间残余肝叶微循环灌注参数(AT、TP、PI、AUC)进行比较,组间两两比较采用LSD法或Dunnett's法;对于同一程度PVS组,采用独立样本t检验对肝门组和非肝门组上述参数进行比较,分析不同类型PVS后残肝微循环灌注变化。结果不同程度PVS组右侧叶AUC随时间呈递增趋势,PVS_(M)组术后第7天AUC均明显高于术后第1、3天[(4918.54±384.46)dB/s vs(2631.53±120.80)dB/s vs(3117.22±434.33)dB/s],PVSS组术后第7天AUC明显高于术后第1天[(3892.09±266.81)dB/s vs(2394.68±408.53)dB/s],差异均具有统计学意义(P=0.014、0.043、0.017);PVSS组术后第7天乳头叶AT明显延长,高于术后第1、2、3天[(5.18±0.56)s vs(3.33±0.24)s vs(3.10±0.52)s vs(3.55±0.35)s],差异均具有统计学意义(P=0.007、0.003、0.015)。术后第1天,PVS_(M)组右侧叶PI明显高于PH组[(35.62±2.42)dB vs(25.11±1.60)dB];术后第7天,PVSS组右侧叶PI和AUC均明显低于PH组和PVS_(M)组[(30.89±0.81)dB vs(39.48±1.22)dB vs(37.03±2.84)dB,(3892.09±266.81)dB/s vs(5383.19±295.45)dB/s vs(4918.54±384.46)dB/s],差异均具有统计学意义(P=0.016、0.025、0.045、0.018、0.039)。不同程度PVS组乳头叶各灌注参数于术后不同时间差异均无统计学意义(P均>0.05)。术后第7天,PVSs肝门组乳头叶PI明显高于非肝门组[(35.85±1.26)dB vs(30.26±0.87)dB],差异具有统计学意义(t=3.655,P=0.022)。结论CEUS可定量评估大鼠70%PH后不同类型PVS引发的肝微循环灌注改变,重度PVS右侧叶灌注明显降低。同一程度、不同部位PVS局部肝叶微循环灌注可出现不同。
Objective To quantitatively analyze the changes of microcirculation perfusion in the remnant liver of rats with different types of portal vein stenosis(PVS)after 70%hepatectomy(PH)by contrast-enhanced ultrasound(CEUS).Methods Seventy-five Sprague-Dawley rats were randomly divided into a PH group(n=15)and two PVS groups with moderate or severe PVS following PH(PVS_(M) and PVSS groups,n=30 each).According to the stenosis site,the PVS groups were further divided into either a hilar group or a non-hilar group(n=15 each).Each group was divided into 5 subgroups at different postoperative times(1,2,3,7,and 14 d),with 3 rats in each group.PH was induced in all rats by 70%hepatectomy,and PVS was induced by different degrees of partial ligation at different sites of the portal vein following PH.At postoperative 1,2,3,7,and 14 d,CEUS was performed to quantitatively analyze the hepatic microcirculation perfusion of the residual right lobe and papillary lobe based on the arrival time(AT),time to peak(TP),peak intensity(PI),and area under the curve(AUC).Single factor analysis of variance was used to compare the residual hepatic microcirculation perfusion parameters(AT,TP,PI,and AUC)among different groups.For groups with PVS of the same severity at different sites,independent sample t-tests were used to compare the above parameters to explore the microcirculation perfusion changes of the residual liver in different types of PVS.Results The AUC of the residual right lobe in the PVS groups increased with time.The AUC in the PVS_(M) group was significantly higher at postoperative 7 d than at 1 d and 3 d[(4918.54±384.46)dB/s vs(2631.53±120.80)dB/s and(3117.22±434.33)dB/s,P=0.014 and 0.043,respectively],and the AUC in the PVSS group was significantly higher at postoperative 7 d than at 1 d[(3892.09±266.81)dB/s vs(2394.68±408.53)dB/s,P=0.017].The AT of the papillary lobe at postoperative 7 d was longer than that at 1,2,and 3 d[(5.18±0.56)s vs(3.33±0.24)s,(3.10±0.52)s,and(3.55±0.35)s,P=0.007,0.003,and 0.015,respectively].At postoperative 1 d,the right-lobe PI in the PVS_(M) group was significantly higher than that of the PH group[(35.62±2.42)dB vs(25.11±1.60)dB,P=0.016],and at postoperative 7 d,the right-lobe PI and AUC in the PVSS group were significantly lower than those of the PH and PVS_(M) groups[PI:(30.89±0.81)dB vs(39.48±1.22)dB and(37.03±2.84)dB,P=0.025 and 0.045,respectively;AUC:(3892.09±266.81)dB/s vs(5383.19±295.45)dB/s and(4918.54±384.46)dB/s,P=0.018 and 0.039,respectively].There was no significant difference in papillary-lobe AT,TP,PI,or AUC among the PVS groups(P>0.05).At postoperative 7 d,the papillary-lobe PI in the hilar group was significantly higher than that of the non-hilar group[(35.85±1.26)dB vs(30.26±0.87)dB,t=3.655,P=0.022].Conclusion CEUS could quantitatively evaluate the hepatic microcirculation perfusion changes induced by different types of PVS following 70%PH in rats,and the right-lobe perfusion in severe PVS is significantly reduced.The microcirculation perfusion of hepatic lobes in rats with PVS of the same severity at different stenosis sites may be different.
作者
马琳
彭驰涵
朱晓霞
范红霞
杨家丽
罗燕
Ma Lin;Peng Chihan;Zhu Xiaoxia;Fan Hongxia;Yang Jiali;Luo Yan(Department of Ultrasound,West China Hospital,Sichuan University,Chengdu 610041,China)
出处
《中华医学超声杂志（电子版）》
CSCD
北大核心
2024年第1期82-88,共7页
Chinese Journal of Medical Ultrasound(Electronic Edition)
基金
水力学与山区河流开发保护国家重点实验室开放课题(SKHL2022)。
关键词
门静脉狭窄
超声造影
微循环灌注
定量分析
鼠
Portal vein stenosis
Contrast-enhanced ultrasound
Microcirculation perfusion
Quantitative analysis
Rat
