胆汁刺激与良性胆管狭窄形成机制的试验研究  

Bile stimulus and study on mechanism of benign biliary stricture

作　　者：何中林[1] 陈平[1] 闫洪涛[1] 还勇为[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所肝胆外科,重庆400042

出　　处：《重庆医学》2008年第15期1699-1700,1703,F0002,共4页Chongqing medicine

摘　　要：目的观察巨噬细胞（M西）及转化生长因子-β1（transforming growth factor-β1）在胆道愈合过程中的表达和分布，探讨胆汁刺激作用与胆管壁慢性炎症的关系，及其在良性胆管狭窄形成过程中的作用及意义。方法实验犬48只（15～18kg），随机分为胆汁刺激组和非胆汁刺激组各24只。胆汁刺激组用切断吻合法，造成胆总管损伤，非胆汁刺激组用切断吻合法，造成胆总管损伤后，同时在吻合胆管上部结扎胆总管，并行胆囊空肠架桥内引流。各组术后再分为1周小组、3用小组、3个月小组、6个月小组。采用免疫组织化学法对MΦ、TGF-β1及平滑肌肌动蛋白（smooth muscle actin）在各组中的表达和分布进行研究。结果MΦ、TGF-β1及平滑肌肌动蛋白（SMA）在胆汁刺激组和非胆汁刺激组表达各期比较差异有统计学意义（P〈0．05），同组内各小组间表达差异无统计学意义（P〉0．05）。结论胆汁刺激作用引起的管壁慢性炎症反应持续存在是造成损伤胆管上皮愈合后M中仍大量聚集，持续合成、分泌TGF-β1、MDGF等生长因子，导致成纤维细胞增殖旺盛，胶原过度合成，管腔瘢痕性狭窄的重要因素。Objective To observe the expression of transforming growth factor-β1 （TGF-β1） and distribution of macrophage and smooth muscle actin （SMA） in the healing process of bile duct and to discuss bile stimulus and implication in the process of benign biliary stricture formation. Methods A repairing model of trauma of bile duct in the dog was made. The dogs were divided into bile stimulus group and no bile stimulus group,each 24 cases. The each group was divided into one-week group,3-week group,3-month group and 6-month group. The expression of TGF-β1 and distribution of maerophages and SMA in the tissue in the different groups after operation were studied by using immunohistochemical envision staining method. Results High expression of macrophages and TGF-β1 and SMA of the bile stimulus group was observed in the healing process and lasted for a long time. Macrophage staining was strong positive in the one-week group,significantly different from that in the other groups （P〈0.05）. Macrophage staining was found at the intrinsic layer under mucosa membrane,TGF-β1 staining at the granulation tissue, fibroblasts and endothelial cells of blood vessels. After 180d post operation,the expression of TGF-β1 and macrophages and SMA of the no bile stimulus group was weaker compared with that in the bile stimulus group. Conclusion The high expression of macrophages and TGF-β1 and SMA of bile stimulus group was related closely with the bile stimulus, fibroblast proliferatingaetively, extraeellular matrix overdeposition and scar proliferation in the healing process of bile duct.

关 键 词：胆管 伤口愈合 胆汁刺激 巨噬细胞 转化生长因子-β1 平滑肌肌动蛋白 

分 类 号：R657.4[医药卫生—外科学]