局部胆管内压大小及持续时间对犬胆管壁的影响

Influence on continuously local intrabiliary duct pressure level on biliary duct wall in dogs

目的探讨局部胆管内压大小及持续时间对犬胆管壁的影响。方法设计并自制一内置入式胆管扩张器,体外测试扩张气囊内压力与注水容积及囊径的关系。将20只杂交犬随机分为五组,A组为假手术组仅在胆总管内放置胆管扩张器;B、C组分别向扩张气囊内注水0.1ml、0.2ml(球囊压力分别为0.24Kpa、0.58Kpa)扩张胆总管10min后抽空气囊并留置胆管扩张器作胆汁引流;D、E组分别向扩张气囊内注水0.1ml、0.2ml扩张胆总管后,不抽空气囊并留置作胆汁引流。各组分别术后7天再次剖腹。观察各组扩张前后血清总胆红素(TB)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)值及胆管直径(BD)变化、胆管壁及肝组织学改变。结果与A组比较,C组扩张后BD增宽(P<0.05)。D组扩张后BD显著增宽(P<0.01),E组扩张后TB、ALT、AST均增高(P<0.01)。A、B组胆管壁组织学无明显变化,C组胆管壁粘膜充血水肿,部分粘膜脱落,D组胆管直径增粗及胆管壁增厚,E组胆管壁部分坏死,与网膜或十二指肠粘连。结论局部胆管内压大小及持续时间对犬胆管壁的影响存在双向互变关系,正常胆管壁在一定的时间内可承受一定的局部胆管内压而不致发生胆管壁的病理变化,适宜的局部胆管内压可引起局部胆管及其上游胆管壁扩张,反之,胆管壁可出现破坏性改变。

Objective To investigate the influence on the size of local intrabiliary duct pressure and continuence for biliary duct wall in dogs. Methods An inlaid bile duct dilator （IBDD） was designed and made by ourself. The relationship between dilated intra-balloon pressure, injcted water volume and diameter of sac were detected in vitro. 21 mongrel dogs were randomly divided into 5 groups. The group A was false operative group and bile duct dilator was placed only in common bile duct. 0.1 and 0.2 ml volume of water were injected to dilated intra-balloon in group B and C respectively （balloon pressure was 0.24 and 0.58 kPa respecvively）. After dilated common bile duct for 10 minutes, the balloon was evacuated and bile duct dilator was placed as biliary drainage. In the group D and E, 0.1 and 0.2 ml volume of water were injeted to dilated intra-balloon respectively. After dilated common bile duct, the balloon was not evacuated and it was placed as biliary dranage. Each group was re-laparostomy after operation 7th day respectively. Value of serum total bilirubin, ALT and AST, and changes of diameter of bile duct （BD）, bile duct wall and liver histology were observed in each group before and after dilatation. Results In comparing with group A, the BD was expanded after dilation in group C （P〈0.05）, BD was expanded obviously after dilation in group D （P〈0.01）, serum total bilirubin （TB）, ALT and AST were increased after dilation in group E（P〈0.01 ）. There was no significant difference in histologic changes of biliary duct wall in group A and B. The biliary duct wall showed mucosal hyperemia and edema and partial mucosal exfoliation in group C. Diameter of bile duct was coarsened and bile duct wall was thickening in group D. Bile duct wall had partial necrosis and it was adhereent to the omentum or duodenum in group E. Conclusion The bidirectional interconversion relationship between the influence on size of local intra-biliary duct pressure and continuence for biliary duct wall in dogs. Normol biliary duct wall can bear local intra-biliary duct pressure in some degree within definite time and it cannot induce pathologic changes. A local suitable intra-biliary duct pressure can lead to dilatation of local bile duct and it＇s bile duct wall of upper stream. On the contrary, bile duct wall would cause destructive changes.