选择性胆道化学栓塞行化学性肝切除的实验研究  

A preliminary study on selective chemical bile duct embolization for chemical hepatectomy

作　　者：沈爱玲[1] 周家华[1] 余泽前[1] 胡亮[1] 陶可涛[1] 

机构地区：[1]东南大学附属中大医院肝胆科

出　　处：《东南大学学报（医学版）》2007年第4期291-294,共4页Journal of Southeast University(Medical Science Edition)

摘　　要：目的：观察不同化学栓塞方法行胆道栓塞后肝脏功能和组织学的变化,探讨胆道化学栓塞行化学性肝切除的可行性和疗效。方法：应用无水乙醇、医用生物胶或无水乙醇联合生物胶对大鼠胆道进行选择性化学栓塞,观察术后肝功能、肝叶质量及病理学变化。结果：术后除无水乙醇加生物胶组4周时碱性磷酸酶（ALP）仍高于正常外,各治疗组ALP、丙氨酸转氨酶（ALT）及总胆红素（TB）均基本正常或稍高于正常。各治疗组肝中叶均有明显萎缩纤维化,体积缩小至正常的1/3～1/2,非治疗肝叶则增生肥大,体积增大1.5～2.0倍;病理学观察显示胆道化学栓塞后胆管壁上皮结构消失,管壁周围淋巴细胞浸润,管壁纤维化,汇管区纤维间隔带明显增宽,成纤维细胞增生,大量胶原纤维生成,胆小管大量增生,肝小叶结构基本消失,肝细胞数量减少。结论：选择性胆道化学栓塞有可能达到化学性肝切除的效果。无水乙醇联合生物胶使胆道引流区域肝组织萎缩纤维化效果最好。单纯无水乙醇进行化学性肝切除也能取得效果,且对机体及肝功能影响较小。Objective To investigate the feasibility, effect of applying some chemical agents in chemical biliary duct embolization （CBDE） for chemical hepatectomy. Methods Absolute ethanol, cyanonacrylate and absolute ethanol plus cyanonacrylate were repectively used as embolization agents. The hepatic function, hepatic lobes weight changes and hetopathological changes were evaluated after CBDE. Results The index of liver function increased quickly during the first several days and decreased to normal level. On postoperative day 3, serum ALP level in absolute ethanol plus cyanonacrylate was much higher than those in other groups（ P 〈 0.05 ）. The embolized lobe had noticeable analosis and fibrosis（P 〈 0.05 ）. Pathological analysis suggested epithelium abolition, bile duct fibrosis, inflammatory cells infiltration, collagen and bile capillary proliferation, hepatic cell death occurred. Conclusions Chemical hepatectomy may be achieved by chemical bile duct embolization. Being embolization agent leading to hepatic lobes fibrosis, absolute ethanol plus cyanonacrylate is the best in inducing liver fibrosis, absolute ethanol is effective with little influence.

关 键 词：胆道 栓塞 肝切除术 肝内胆管结石 大鼠 

分 类 号：R657.4[医药卫生—外科学]