胆道消融剂在选择性胆道消融栓塞中的选用

Preliminary screening of some chemical agents for selective bile duct ablation and embolization

目的观察不同胆道消融剂选择性胆道消融栓塞对肝脏结构和功能的影响。方法无水乙醇、醋酸、盐酸、氢氧化钠分别消融胆道,OB胶栓塞巴马小型猪左外叶胆管,观察术后肝功及病理变化。结果术后各组肝功能各项指标除白蛋白外,均出现一过性增高,术后两周内恢复正常。无水乙醇肝功变化没有其他组显著。其它各组坏死范围较无水乙醇大。其中氢氧化钠出现急性肝坏死,醋酸坏死范围大于左外叶。光镜下左外叶汇管区纤维明显增生,肝细胞数目减少,假小叶形成。Masson染色提示胶原纤维显著增生。结论无水乙醇与OB胶联合使用,行选择性胆道消融栓塞能使消融栓塞胆道引流区域肝组织萎缩纤维化,肝内假小叶形成。而且对机体影响最小,是目前安全的胆道消融剂。

Objective To screen some chemical agents for selective bile duct ablation and embolization （SBAE）. Methods 16 Bama swines were divided into four groups randomly. Alcohol, acetic acid, hydrochloric acid and sodium hydroxide were used as ablation agents in each group respectively. The pathological changes and liver function were evaluated after SABE. Results On postoperative day 2, serum AST and ALP levels in sodium hydroxide group were much higher than in other groups （ P〈0.05）. Acute liver necrosis appeared. T-BIL level in acetic acid group was the highest （P〈0.05）. There was no significant difference in collagen proliferation in 4 groups （P〉0.05）. The index of liver function increased quickly during the first several days and decreased to normal levels on week 2 postoperation. Pathological analysis suggested hepatic cell death, bile duct fibrosis, inflammatory cells infiltration and fibroblast proliferation occurred. Liver atrophy and fibrosis were obvious on week 5. Masson stain suggested collagen increased remarkably 5 weeks after ablation （ P 〈0.05）. Conclusions Alcohol is the safest chemical agent in SBAE.