VIOLATION OF SUCTION FUNCTION OF THE SMALL INTESTINE AT POSTRESECTION PORTAL HYPERTENSION
DOI:
https://doi.org/10.11603/2415-8798.2018.2.8922Keywords:
liver resection, small intestine, suction, morphometry.Abstract
The liver resection is widely used in modern surgical clinics. Removal of large volumes of liver leads to postresection portal hypertension, which is complicated by bleeding from varicose veins of the esophagus, stomach, rectum, ascites, splenomegaly, secondary hypersplenism, parenchymal jaundice, and portosystemic encephalopathy. The widespread prevalence of this pathology, high mortality from its complications indicates that it is an important medical and social problem.
The aim of the study – to learn the features of the suction function of the small intestine at postresection portal hypertension.
Materials and Methods. The research was conducted on 45 laboratory-sexually mature white male rats, which were divided into 3 groups. The 1 group consisted of 15 intact virtually healthy animals, 2–15 rats after resection of the left lateral part – 31.5 % of liver parenchyma, 3–15 animals after removal of the right and left lateral parts of the liver (58.1 %). One month after the start of the experiment, the suction function of the small intestine was investigated for the D-xylose test. It is specified chemical agent is an inert carbohydrate which is absorbed by passive diffusion. D-xylose is not metabolized in the human body and animals, is excreted in the urine, fully and adequately reflects the suction function of the small intestine. From the small intestine made histological micropreparations. Morphometrically determined the height of the epitheliocytes of the mucousa of the intestine, the diameter of their nuclei, nuclearcytoplasmic relations in them, the relative volume of their damage. Quantitative indicators were processed statistically.
Results and Discussion. It was found that one month after resection of 31.5 % of liver parenchyma, the content of D-xylose in urine decreased by only 5.1 %, indicating a slight disruption of the absorption function of the small intestine, and resection 58.1 % of the liver decreased of D-xylose in urine by 28.6 %. The latter figure testified to a marked violation of the suction function of the small intestine. One month after resection, 58.1 % of liver parenchyma decreased the height of epithelial cells by 19.4 % compared with the same control quantitative morphological parameters, and the diameter of their nuclei – only by 2.3 %. Non-uniform disproportionate changes in spatial characteristics of the nucleus and cytoplasm of the epithelial cells resulted in marked violations of nuclear-cytoplasmic relations in these cells. At the same time, the indicated morphometric parameter is statistically significantly (p <0.001) increased by 47.9 %, which indicated an alteration of structural cellular homeostasis. Relative volume of damaged endothelial cells a month after removal of 58.1 % of liver parenchyma increased 21.3 times. Significant correlation between the concentration of D-xylose in urine, nuclear-cytoplasmic ratios in epitheliocytes and the relative volume of damaged epithelial cells was found, which allowed to confirm the close relationship between structural changes in mucosa of the intestine and violation of the suction function in the simulated experimental conditions. Consequently, significant resection of the liver parenchyma leads to posresection portal hypertension, severe lesions of the mucosa of the intestine, which significantly impairs the suction function of the small intestine.
Conclusions. Resection of 58.1 % of liver parenchyma leads to postresection portal hypertension and severe structural rearrangement of the epitheliocytes of the mucosa of the small intestine, which is confirmed by a disturbance in their cellular structural homeostasis and a significant increase in the relative volume of their damage, which was complicated by a significant violation of the suction function of the small intestine.
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