梗阻性胆管损伤一期修复时机的选择  

Experimental study on surgical timing for obstructive biliary injury repair

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] 王世杰[1] 

机构地区：[1]安徽省立医院普通外科胆胰病区,合肥230001

出　　处：《中华消化外科杂志》2011年第2期116-119,共4页Chinese Journal of Digestive Surgery

基　　金：安徽省科技攻关计划面上项目（08010302189）

摘　　要：目的 观察胆管梗阻性损伤后的病理学改变,为胆管修复手术时机的选择提供理论依据.方法 建立家犬梗阻性胆管损伤模型,将60只家犬按照梗阻时间的长短分为胆管梗阻5 d组（BDL5组）,胆管梗阻10 d组（BDL10组）,胆管梗阻15 d组（BDL15组）,胆管梗阻20 d组（BDL20组）和胆管梗阻30 d组（BDL30组）,每组12只.由于对照组的取材不影响后期实验,即将BDL5组同时作为对照组.动态观察胆管梗阻性损伤后不同时间段内的胆管形态学和局部组织病理学的变化,并在相应时间内施行胆管空肠Roux-en-Y吻合术进行胆管修复,观察家犬胆管修复后的近期疗效.采用单因素方差分析、LSD法、独立样本t检验和x2检验分析数据.结果 胆管梗阻性损伤后,近端胆管随着压力的增加而持续扩张,前期扩张迅速,BDL10组胆管扩张至（15.6±1.8）mm,后期扩张缓慢,BDL15组胆管扩张至（18.9±1.9）mm;损伤胆管局部组织出现急性炎症反应,BDL5组胆管炎症反应最重,单位面积的WBC数量达到（54±6）个,BDL15组胆管炎症反应明显减轻,单位面积的WBC数量为（42±7）个.两组比较,差异有统计学意义（t=4.688,P＜0.05）.随着时间的延长,损伤胆管壁内的胶原含量不断增加.60只家犬中57只顺利完成胆管修复手术.术后10只家犬因发生胆汁漏死亡,其中BDL5组3只,BDL10组4只,其他组各1只;10 d内胆汁漏发生率为30%（7/23）,10 d后胆汁漏发生率为9%（3/34）,两者比较,差异有统计学意义（x2=4.429,P＜0.05）.结论 胆管梗阻性损伤10 d后,胆管扩张,局部组织及胆管炎性水肿明显减轻,手术操作难度较小,且术后家犬胆汁漏发生率低,故建议胆管梗阻性损伤10 d后再进行手术修复.Objective To observe the pathological changes of tissues of the injured bile duct, and to provide theoretical basis for bile duct repair. Methods Dog models of obstructive biliary injury were established.Sixty dogs were equally divided into five groups according to the duration of biliary obstruction： biliary obstruction for 5 days （BDL5 group）, 10 days （BDL10 group）, 15 days （BDL15 group）, 20 days （BDL20 group） and 30 days （BDL30 group）. The morphological and pathological changes of bile duct and local tissues were observed, and biliary-enteric Roux-en-Y anastomosis was applied to repair the injured bile duct and postoperative complications were observed. All data were analyzed by LSD test, independent sample t test, one-way analysis of variance and chi-square test. Results Proximal bile duct rapidly expanded as the pressure increased in the early stage, and the bile duct expanded to （ 15.6 ± 1.8）mm in the BDL10 group. The expansion rate decreased in the later stage,and the bile duct expanded to （18.9 ± 1.9）mm in the B DL15 group. Acute inflammation was observed in injured local tissues. The acute inflammation was severe in the BDL5 group with white blood cell count of 54 ± 6, and the acute inflammation was relatively mild in the BDL15 group with white blood cell count of 42 ± 7. There was a significant difference between the BDL5 group and BDL15 group in the degree of acute inflammation （t =4. 688,P ＜ 0. 05）. The content of the collagen was increased in the injured bile duct as time passed by. Bile duct repair was successfully performed on 57 dogs. Ten dogs （ three in the BDL5 group, four in the BDL10 group, one in the BDL15 group, one in the BDL20 group and one in the BDL30 group） died of bile leakage after the operation. The incidences of bile leakage was 30% （7/23） within 10 days and 9% （3/34） beyond 10 days, with a significant difference between the two groups （x2 =4.429, P＜0.05）. Conclusion Ten days after obstructive biliary injury,an obvious reduct

关 键 词：胆管损伤 阻塞性黄疸 胆管修复 时机 

分 类 号：R657.4[医药卫生—外科学]