跨越壶腹部支架对犬胆道压力和Oddi括约肌病理学影响的实验研究  

Impact of Transpapillary Stent Placement on Biliary Pressure and Pathology of Sphincter of Oddi:an Experimental Study

作　　者：温锋[1] 卢再鸣[1] 郭启勇[1] 毛晓楠[1] 梁宏元[1] 

机构地区：[1]中国医科大学附属盛京医院放射科,辽宁沈阳110004

出　　处：《中国医学影像学杂志》2010年第6期510-515,共6页Chinese Journal of Medical Imaging

基　　金：辽宁省高等学校创新团队项目计划(2006T132)

摘　　要：目的:探讨跨越壶腹部支架置入后犬胆道压力和Oddi括约肌(sphincter of Oddi,SO)病理学的变化机制。材料与方法:选取成年实验犬5只,建立经皮经肝胆囊穿刺和跨越壶腹部置入金属支架的模型,应用胆道测压的方法比较支架置入前和支架置入5周后十二指肠压(duodenal pressure,DP)、SO基础压(sphincter of Oddi basal pressure,SOBP)、收缩幅度(sphincter of Oddi contractive amplitude,SOCA)、收缩间期(sphincter of Oddi duration,SOD)以及胆总管压(common bile duct pressure,CBDP)的变化。同时,应用胶原纤维染色观察支架置入后SO的病理变化。对实验所获得的计量资料采用配对t检验进行比较,P<0.05为差异有统计学意义。结果:以DP作为零点,获得其他各项指标的相对值结果。支架置入前SOBP、SOCA、SOD、CBDP分别为:13.69±4.29mmHg、42.65±8.50mmHg、6.69±1.46s、12.98±2.86mmHg;支架置入5周后分别为:10.58±3.98mmHg、31.95±9.00mmHg、4.47±1.21s、7.43±2.20mmHg,其中SOCA较支架置入前降低,SOD相比支架置入前缩短,两者的差异均有统计学意义(P<0.05)。而CBDP明显低于支架置入前,差异具有统计学意义(P<0.05)。支架置入5周后,壶腹部SO肌层中发生了不同程度的纤维化、腺体病变和炎性反应等病理变化。结论:跨越壶腹部植入支架5周后,SO运动功能的减弱以紧张性收缩的减弱为主,而基础性收缩仍然存在。CBDP虽然下降,但仍高于正常的DP,并保持与之的压力梯度,从而为抑制肠胆反流提供了可能。而壶腹部SO肌层中则发生了不同程度的纤维化、腺体病变和炎性反应等病理变化。Purpose This study aimed to discuss the mechanism on the changes of the biliary pressure and pathology of sphincter of Oddi after metallic stent placement across the duodenal papilla in dogs.Materials and methods Five healthy adult dogs were selected,and an animal model was accomplished by implanting the metallic stent across the duodenal papilla through percutaneous transhepatic biliary puncture.With the biliary manometry,the measured results of DP,SOBP,SOCA,SOD,and CBDP were recorded and compared before and after stent.At the same time,the histopathological changes were observed in the papilla after placement of stent across the duodenal papilla through Van Gieson（VG）staining.The test was employed to compare the data.P〈0.05was considered as statistical significance.Results Biliary puncture and manometry were successfully performed in all five dogs.DP was regarded as zero,and the relative results were obtained.Before stent placement,the results of SOBP,CBDP,SOCA,and SOD,were 13.69±4.29mmHg,12.98±2.86mmHg,42.65±8.50mmHg,and 6.69±1.46srespectively;after 5weeks of stent implantation,the results were as follows,10.58±3.98mmHg,7.43±2.20mmHg,31.95±9.00mmHg,and 4.47±1.21srespectively.Compared with those before stent implantation,SOCA was lower and SOD was shortened,and there were significant differences（P〈0.05）.CBDP was significantly lower than that before stent implantation,with statistically significant difference（P〈0.05）.After 5weeks of stent implantation across the duodenal papilla,there were histopathological changes such as fibrosis,glandular lesions and inflammatory reaction of varying degrees in ampulla muscle.Conclusion After 5weeks of stent implantation across the duodenal papilla in dogs,the changes of SO motor function manifested mainly as the weakened phasic contraction,but there still had basic contraction.Although decreasing,the CBDP was still higher than normal DP,and the pressure gradient to the duodenum maintained.Thus prevention of duodenobiliary reflux was possible.There we

关 键 词：胆总管 奥狄括约肌 肝胰管壶腹 压力 支架 

分 类 号：R657.4[医药卫生—外科学]