胆道闭合性损伤后手术时机选择的实验研究  

An experimental study on determination of surgical opportunity after closed bile duct injury

作　　者：黄立嵩[1] 张永杰[1] 俞文隆[1] 史嵩[1] 杨珏[1] 王雷[1] 施鹏[2] 

机构地区：[1]第二军医大学东方肝胆外科医院胆道一科 [2]第二军医大学卫生统计学教研室

出　　处：《中华肝胆外科杂志》2007年第11期760-763,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的建立胆道闭合性损伤动物模型,探讨闭合性胆道损伤后手术时机的确定。方法结扎36只SD大鼠胆总管,建立胆道闭合性损伤模型,随机分为12组,每组3只,分别于阻塞性黄疸后第0(正常对照组)、1、4、7、11、15、23、30、48、63、71、90天共计12个时间点取大鼠梗阻段胆管,做胆管和肝脏的病理切片及免疫组化,观察并检测胆管壁炎症水肿程度及转化生长因子β1(transforming growth factorβ1,TGF-β1)在胆道损伤后不同时期的表达强度,并绘制胆管壁炎症水肿程度和TGF-β1表达量的关系曲线。各时间点取血检测肝功能各项指标并绘制时间变化曲线。结果胆总管完全梗阻的情况下,胆管壁在损伤发生后4d内迅速发生炎症和水肿,在第23天前后炎症水肿达到最高峰,以后逐渐减弱,30d以后炎症水肿基本达到稳定水平,但仍高于损伤后2d且低于损伤后第4天的水肿程度;随着时间的增加,胆管壁的TGF-β1表达量逐渐增加,在48d左右达到最高值,以后逐渐减少,80d以后接近正常水平。病理HE染色及血清TBIL、DBIL、IBIL、ALB、ALT和AST等指标,提示胆道完全梗阻超过3周以后,肝脏发生不可逆的损伤。结论胆道闭合性损伤后,应该在损伤后2d内及早行手术治疗,这是胆道闭合性损伤的最佳手术治疗时机;如果错过了该时机,应尽早进行保守治疗或先行胆管T管引流后再于损伤后30～40d或80d以后行手术治疗。Objective To discuss the determination of surgical opportunity after closed bile duct injury by establishing the animal model of the closed bile duct trauma. Methods The common bile duct of 36 Sprague-Dawley rats was ligated to establish the model of closed bile duct injury. They were randomized into 12 groups with 3 in each. The obstructive section of the bile duct was extracted sepa rately at 12 time phases after producing the obstructive jaundice at 0, 1, 4, 7, 11, 15, 23, 30, 48, 63, 71 and 90d. Meanwhile, the pathological sections of the obstructed bile duct and liver were made and immunohistochemistry was used to observe and examine the degree of bile duct wall inflammation and dropsy and the expression intensity of transforming growth factor β1 （TGF-β1） at different time phases after bile duct injury. The relational curve between the degree of bile duct wall inflammation and dropsy and TGF-β1 expression quantity was drawn. Furthermore, blood samples were collected from all the rats at each time phase to determine liver functional indexes. Results In the situation of common bile duct being obstructed completely, the common bile duct wall had the inflammation and dropsy rapidly in 4 days after damage, the degree of inflammation and dropsy reached the peak in about 23 days. Later it was weakened gradually and 30 days later it achieved the stable level basically. However, it was still higher than that of 2 days and be lower than that of 4 days after damage. With time prolongation, the TGF 131 expression quantity of bile duct wall increased gradually and achieves the maximum quantity in about 48 days. Then it decreased gradually and it returned to the normal 80 days after the damage. Pathologic examination showed that the liver was not of reversible damage after the bile duct was obstructed completely for 3 weeks. Conclusions When the bile duct has the closed trauma, it should be treated by the surgery in 2 days after trauma, which is the best opportunity for surgical treatment. If this best oppo

关 键 词：胆道损伤 瘢痕 炎症 转化生长因子Β 

分 类 号：R657.4[医药卫生—外科学]