大鼠重症急性胰腺炎腹腔置管引流灌洗时机对病程转归及胰腺病理改变的影响  

Influence of timing of peritoneal catheter drainage and lavage on the outcome and pathological changes of pancreas in the rat model of severe acute pancreatitis

作　　者：朱雷明[1] 杨静[2] 周欣峰[1] 陆吉麟[3] 陶琨[2] 郑敏[1] 郑涛[1] 

机构地区：[1]上海市长宁区中心医院普外科,上海200336 [2]上海市长宁区中心医院病理科,上海200336 [3]上海交通大学医学院附属上海市第一人民医院普外科,上海200080

出　　处：《外科理论与实践》2013年第4期358-363,共6页Journal of Surgery Concepts & Practice

基　　金：上海市卫生局科研基金(2010144)

摘　　要：目的:重症急性胰腺炎(SAP)起病急遽、进展迅速、死亡率高。早期腹腔置管引流对部分病人可缓解病情。本研究拟在大鼠SAP模型中探讨腹腔引流的时机和方式,观察对病程转归和胰腺病理学形态的影响。方法:清洁级SD大鼠,随机分为SAP模型组、早期引流组、延期引流组、早期灌洗组、延期灌洗组和手术清创引流组。SAP大鼠模型采用胰胆管顺行注射牛磺胆酸钠法建立。比较各组24 h后大鼠存活率,观察胰腺病理学改变。结果:SAP大鼠模型组和清创引流组24 h后存活率差异无统计学意义。早期引流组存活率显著提高(P<0.01)。延期引流组、延期灌洗组与模型组存活率差异无统计学意义(P>0.05)。采用5 mL/h生理盐水行早期灌注24 h存活率与模型组无统计学差异(P>0.05),但是采用2 mL/h生理盐水行早期灌注24 h存活率高于模型组(P<0.05)。引流组和灌洗组3 h、6 h和24 h胰腺病变仍成加重发展趋势。但是引流组和灌洗组24 h后胰腺病变程度比SAP模型组和手术清创引流组轻。结论:在SAP病程早期进行腹腔置管引流可降低大鼠死亡率。仅靠腹腔引流或灌洗不能终止SAP病程。Objective Severe acute pancreatitis （SAP） is characterized by sudden onset, rapid progress and high mortality rate. The early use of peritoneal catheter drainage might help the recovery from the disease in a subgroup of patients with SAP. This study aimed to evaluate the effect of the timing and pattern of drainage on the outcome and the pathological change of pancreatic tissues in a rat model of SAP. Methods Clean-grade male Sprague-Dawley rats were used and the SAP rat model was established with a sodium taurocholate antegrade injection via the biliopancreatic duct. The rats were randomly divided into SAP model only group （control group）, early drainage group, delayed drainage group, early lavage group, delayed lavage group and surgical debridement group. The survival rate after 24 h were compared among groups. The pathologic changes of pancreatic tissues were observed. Results No difference of survival rate existed between SAP model group and surgical debridement group （P〉0.05）. The survival rate of early drainage group was significantly higher than that of SAP model group （P〈0.01）. Neither delayed drainage group nor delayed lavage group had significant difference in survival rate compared with SAP model group （P〉0.05）. There was no difference between the survival rate of early lavage group with 5 mL/h of saline and that of SAP model group （P〉0.05）, while those lavaged with 2 mL/h had significantly higher survival rate compared with that of SAP model group （P〈0.05）. The pathological change of pancreas at 3 h, 6 h and 24 h tended to be worsen in both drainage and lavage group. However, the lesion in pancreas after 24 h in drainage group and lavage group was less than that in the SAP model group and surgical debridement group. Conclusions The mortality rate can be decreased by early abdominal drainage in SAP rat model. However, abdominal drainage or lavage alone is not enough to stop the progress of SAP.

关 键 词：重症急性胰腺炎 病理改变 腹腔置管引流 生存率 

分 类 号：R576[医药卫生—消化系统]