胆总管急性梗阻时胆道压力胆管扩张黄疸三者的关系  

Correlation among pressure, diameter, and jaundice in acute obstruction of common bile duct

作　　者：吕云福[1] 王保春[1] 宫晓光[1] 韩晓玉[1] 张世杰[2] 刘宁[1] 翁少文[1] 

机构地区：[1]海南省人民医院普外科,海口570311 [2]广东省开平市中心医院外科

出　　处：《中华实验外科杂志》2011年第11期1851-1852,共2页Chinese Journal of Experimental Surgery

摘　　要：目的探讨胆总管急性梗阻时胆道压力、胆管扩张、黄疸三者的关系。方法犬10条，在十二指肠上缘的胆总管内置入连接自动测压装置系统直经为3．5mm的小管，先测胆道基础压和胆总管直径，然后转开三通开关，通过直经3．5mm小管向胆总管内滴人美蓝盐水（NS100ml＋美兰60mg），20滴／min，等于造成胆道梗阻，按结果中显示的时间段测量胆道压力和胆总管直径，并观察美兰染色的胆汁返流至肝脏的情况。结果滴人美兰盐水前，胆道压力为〈8mmHg（1mmHg=0．133kPa），胆总管直径为4．0mm，肝脏色泽正常。经3．5mm测压管向胆管内滴入美兰盐水7rain后，胆道压力上升至15．42mmHg，胆总管直径增宽至5．5nm；15min后，胆道压力上升至20mmHg，胆总管直径6mm，肝脏开始变蓝、表示胆管内胆汁巳向肝内染色返流；30min后，胆道压力上升至34mmHg，胆总管直径6．7mm，肝脏美蓝染色加深；45min后，胆道压力21mmHg，胆总管直径7．5mm，肝脏呈深蓝色；60min后，胆道压力18mmHg，胆总管直径7．5mm。结论胆道压力升高后先有胆管扩张，后有黄疸；在一定范围内，胆管扩张程度与胆道压力呈正相关；黄疸程度与胆道压力和胆管扩张程度呈正相关。但胆道压力上升至34mmHg时不再升高，胆管扩张至7．5mm时不再扩张，表明胆道压力和胆管扩张均有一定的自限度。Objective To investigate the relationship between the pressure, diameter, and jaundice in acute obstruction of the common bile duct （CBD）. Methods An automatic pressure measurement device was placed through a small tube （ D = 3.5 mm） into the CBD on the upper entrance of the duodenum. The pressure and diameter of the CBD were detected. The switch was then turned on and methylene blue （MB） in saline （NS 100 ml ＋ MB 60 mg, 20 drops/rain） was infused into the CBD to create CBD congestion. The pressure and diameter were detected according to the time set, and the reflux of MB to the liver was observed. Results Before the MB was injected, the pressure of the CBD was hower than 8 mm Hg （ 1 mm Hg =0. 133 kPa）, the diameter was 4. 0 mm, and the color of the liver was normal. Seven rain after the MB was introduced, the pressure was increased to 15.42 mm Hgaud the diameter widened to 5.50 mm. Fifteen rain after introduction the pressure was increased to 20 mm Hg and the diameter widened to 6. 00 mm, the liver surface began to turn blue, indicating that the bile had begun to reflux into the liver. After 30 rain, the pressure was increased to 33 mm Hg, the diameter widened to 6. 7 mm, and the blue liver color enhanced. After 45 min, the pressure was increased to 21 mm Hg, the diameter widened to 7.5 mm, and the color of the liver was dark blue. After 60 min, the pressure was increased to 18 mm Hg and the diameter widened to 7.5mm. Conclusion After the pressure rises, increase in the diameter is observed, followed by jaundice. Within a certain range, bile duct dilatation is positively correlated with the biliary pressure. The degree of jaundice and biliary duct dilatation pressure are also positively correlated. However, when the biliary pressure rises to 33 mmHg, it no longer increases, while the expansion of the width to 7.5 mm also no longer continues, indicating that duct dilatation and pressure are both self-limiting.

关 键 词：胆总管急性梗阻 胆道压力 胆管扩张 黄疸 

分 类 号：R657.4[医药卫生—外科学]