凝固線溶系の検討による急性門脈遮断とその問題点

抄録

Chages in blood coagultion and fibrinolysis by acute portal vein occlusion were investigated using adult mongrel dogs.
All five dogs died within 81-130 minutes (mean: 105 minutes) after the ligation of the portal vein, and portal system became to be in hypercoagulable state. Deposition of fibrin was observed in capillary vessels in the mucous membrane of the small intestine 1.0 minutes after the ligation of the portal vein. Thus histological examination proved DIC. Before ligation of portal vein, a high degree of activity of tissue plasminogen activator was noted in the small vessels, mainly of the submucosal layer of the small intestine. However a significant decrease of its activity was observed after the ligation of the portal vein, and finally it disappeared within 20 minutes. This suggested the progression of the process into irreversible DIC. After simultaneous occlusion of portal vein and superior mesenteric artery, the same changes were demonstrated later than portal vein ligation alone, and these five dogs died within 70-195 minutes (mean: 138 minutes).
However, by bypassing portal blood into the femoral vein through the heparinized hydrophilic catheter (Anthron^®) under complete ligation of the portal vein, these deteriorating changes were not observed, and these five dogs survived in good condition for long period. Thus, a safe method for preservation of portal bed circulation during temporary shut-down of the portal vein has been established.