梗阻型胆道损伤后选择手术修复时机的实验研究  

The timing of surgical repair for obstructed biliary injury

作　　者：黄强[1] 刘臣海[1] 王成[1] 胡元国[1] 邱陆军[1] 汤志刚[1] 王士堂[1] 林先盛[1] 王世杰[1] 谢放[1] 

机构地区：[1]安徽省立医院普外科胆胰病区,合肥市230001

出　　处：《实用医学杂志》2011年第3期389-392,共4页The Journal of Practical Medicine

基　　金：安徽省科技攻关计划面上项目(编号:08010302189)

摘　　要：目的:探索梗阻型胆道损伤后的最佳手术修复时机。方法:运用家犬制作梗阻性胆道损伤的动物模型,通过动态观察梗阻损伤后不同时间段的胆管形态学、局部组织及肝脏病理学和机体生理机能等指标的改变情况,从中获得胆道损伤后局部环境及机体条件符合修复的最佳时间段。结果:胆管梗阻型损伤后,近端胆管随着胆管内压的增高而扩张,早期(10d内)扩张迅速,而后扩张速度减缓;损伤胆管出现急性炎症反应,管壁炎性细胞浸润,黏膜水肿,管壁水肿性增厚,以第5天最重[HE染色WBC计数(54.2±5.8)个],10d之后炎性细胞浸润减少,水肿减轻,至第15天炎症消退明显[HE染色WBC计数(41.7±7.2)个,P<0.05],同时在胆道持续梗阻状态下,机体的血清於胆指数(TBIL、DBIL和ALP)在阻塞早期(第5天)即达到最高,而后出现一个平台期,且轻度下降,至实验末期(第30天)时出现急剧上升;而酶学指标ALT和AST也出现类似改变,但梗阻到第20天后出现轻度升高后再次下落,与胆红素形成"胆酶分离"现象;肝细胞由梗阻早期(10d内)浊肿变性伴脂肪变性发展为广泛的空泡变性及肝窦闭塞。结论:综合损伤胆管的局部形态学及全身机能的变化规律,急性梗阻型胆管损伤后10～20d之间是进行一期修复的较好时间段,以15d左右最为理想。Objective To explore the optimal timing of surgical repair for obstructed biliary injury. Methods A canine model of obstructed biliary injury was established. The changes in the morphology of bile duct, local tissues and hepatic pathology, and physiological function were observed at different time points. Results After obstruction of bile duct, the proximal bile duct dilated rapidly at the early stage because of the increased bile duct pressure and the dilation slowed down on day 15. The injured bile duct developed acute inflammatory response, with the worst inflammatory cell infiltration, mucosal edema, and edematous thickened wall on day 5 （WBC count 54.2 ± 5.8）; inflammatory cell infiltration and mucosal edema reduced on day 10; and inflammation vanished obviously on day 15 （WBC count 41.7 ±7.2, P 〈 0.05）. During biliary obstruction, bilirubin reached the highest level at the early stage （BDL 5 group）, then presented a platform, even declined slightly, and then rised extremely at the late stage （BDL 30 group）. ALT and AST had the similar changes. It occurred a decline after a mild rise on day 20 and showed bilirubin-enzyme separation. The liver cells became massive vacuolar degeneration and hepatic sinusoid obstruction on day 20 from adipose degeneration and hepatic sinusoid hyperemia at the early stage. Conclusions Based on the morphological changes in the injured bile duct and the changes of physical function after bile duct obstruction. The period between 10 and 20 days after acute bile duct injury is a good time for the surgical treatment.

关 键 词：黄疸 阻塞性 胆道损伤 手术治疗 时机 胆红素 病理学 

分 类 号：R657.4[医药卫生—外科学]