摘要
目的探讨实验性梗阻性胆道损伤后手术修复的时机。方法将60只健康家犬制成梗阻性胆管损伤的动物模型，随机分为5组（n=12），分别为梗阻5d，梗阻10d，梗阻15d、梗阻20d和梗阻30d组，对照组为模型建立之前的正常犬。动态观察梗阻损伤后不同时间段的胆管形态学、局部组织病理学及肝脏功能变化指标，并于各组获得组织标本后即刻行胆肠Roux—en—Y吻合修复胆道，观察胆道梗阻性损伤修复术后犬并发症及生存情况。数据采用单因素方差分析进行分析。结果胆管梗阻性损伤后，近端梗阻胆管持续扩张，第10天达（15．6±1．7）mm；损伤胆管局部组织出现急性炎症反应，以梗阻5d时最严重（HE染色、WBC计数54±6个），梗阻第15天时炎症消退明显（HE染色、WBC计数42±7VS54±6个，P〈0．05），同时胆管壁由早期（第5天）的炎性水肿样增厚，改变成纤维增生性增厚（第15天）；在梗阻性黄疸状态下肝功能发生规律性生理改变，血清TBIL、DBIL和ALP值在阻塞5d组最高，至梗阻30d时急剧上升（P〈0．05）；而酶学指标ATT和AST在迅速升高后，在梗阻20d后下降（P〈0．05），表现为“胆酶分离”现象；其中57只犬成功经受胆道修复手术，10只犬术后10d内因胆漏死亡，其中损伤10d内修复的胆漏7只，损伤10d后修复的胆漏3只（P：0．025），术后观察发现，梗阻性损伤后3个月内营养及脏器衰竭死亡13例，其中梗阻5d和梗阻10d组各1例，梗阻15d和20d组各2例，梗阻30d组7例（P〈0．05）。结论胆道梗阻后10～20d机体处于代偿期，且炎性水肿减轻明显，手术操作难度较小，此时行手术修复，胆漏发生率和器官衰竭率较低，手术容易获得良好效果。
Objective To explore the optimal timing of operation for experimental obstructive jaundice in a dog model. Method A dog model of bile duct stricture （BDS） was established. Dogs were divided into （n =12 in each group） 6 groups, ie control, BDS days 5, 10, 15, 20, and 30. In each dog, the morphology and local histopathology of the bile duct, and the liver function in different periods were observed. At the time of surgery biopsy was taken and Roux-en-Y hepaticojejunostomy performed. Surgical complications and survival were evaluated. Result After bile duct obstruction, the proximal bile duct dilated continuously. The diameter of bile duct was 15. 6 ± 1.7 mm at the lOth day. The injury bile duct showed the acute inflammation change. In the early time （in 10 days） , inflammatory cells increased in the tissues, mucous edema aggravated, the wall was edematous thickening, it was most severe （WBC counting 54 ±6） in the 5th day. In the later period （10 -30 days） , inflammatory ceils reduced, bile duct wall became fibrosis, which was most obvious in the 15th day （42 ± 7 vs 54 ± 6, P 〈 0. 05 ）. During the development of jaundice, serum bilirubin reached the highest level in the early period （ BDS days 5 group）, then presented a platform time, and then rised extremely at the last stage of the experiment （BDS day 30 group） . Changes of ALT and AST paralleled that of bilirubin before the 20th day of obstruction and then plummeted. BDS was repaired successfully in 57 dogs. Ten dogs died postoperatively due to bile leakage within 10 days, 3 dogs in BDS days 5 group （3/11）, 4 in BDS days 10 group （4/12）, one each in other groups. Postoperatively 13 BDS dogs died of malnutrition and organ failure within 3 months, including one each in days 5 and days 10 group, two each in days 15 and days 20 group, and 7 in days 30 group （ P 〈 0. 05）. Conclusion Considering the changes of morphology, physical function and result of follow up. The period between 10 and 20 days after acute bile duc
出处
《中华普通外科杂志》
CSCD
北大核心
2011年第2期130-133,共4页
Chinese Journal of General Surgery
基金
安徽省科技攻关计划面上项目（项目编号：08010302189）
关键词
黄疸
阻塞性
模型
动物
胆道
创伤和损伤
外科手术
Jaundice, obstructive
Models, animal
Biliary tract
Wound and injury
Surgical procedures, operative
