“化学性胆囊切除术”的实验研究

EXPERIMENTAL STUDY ON "CHEMICAL CHOLECYSTECTOMY

为研究胆囊化学切除硬化剂及可行性，将32只兔分4组(n=8)。剖腹直视下金属夹/丝线阻断胆囊管，底部造口注入硬化剂。1组：95％乙醇+5N三氟醋酸（TFA）；2组：95%乙醇+2N TFA；3组：95%乙醇+1M TFA；4组：生理盐水（对照）。2、4、8周分批处死动物，胆囊作大体、光镜、透射电镜观察。结果：2周胆囊粘膜脱落坏死，4-8周纤维疤痕化。1、2组纤维化成功率高于3组，有显著性差异（1、2组∝3组；P<0.05），1、2组之间无显著性差异（P>0.05）。1组见肝细胞损害，3组有粘膜上皮再生。血管夹与丝线对致纤维化率无差异（P>0.05）。结论：胆囊硬化治疗后4-8周形成纤维疤痕，95%乙醇+2M TFA效果最佳，金属夹能阻断胆囊管。

In this experiment, 32 rabbits were divided into four group (Gl .2.3.4) . After cystic duct was occluded by silk ligation or hemoclip clamp, gallbladder mucosa was treated by the following agents: 95% ethanol + 5m/2m/lm trifluoroacetic acid (TFA) respectively (G1.2.3) and NS (G4) . The animal were killed at the end of 2, 4, 8 weeks postoperatively, and the galldladder tissue was observed by microscopy and electromicroscopy. The results showed that at the end of 2 weeks, inflammation on the wall of the gallbladder and necrosis of the mucosa were occurred. Fi-brosis and scar formation of gallbladder were found on the 4 - 8 weeks after operation. Fibrosis formation in Gl and G2 was higher than that in G3 (P<0.05) ; but in Gl was similiar to G2 (P >0.05), Liver damage was found in G1; reepithelialization occured in G3. Compared with silk ligation, hemoclip clamp was more effective in occluding the cystic duct (P>0.05) .Conclusion: complete fibrosis formation can be obtained in 4-8 weeks after gallbladder scle-rotherapy; 95% ethanol + 2m TFA is the most promising sclorotherapy agent; hemoclip clamp can occlud cystic duct completely.