微创可复梗阻性黄疸模型的建立

Reproduction of a microsurgical reversible obstruction jaundice model

目的探讨建立适合内镜外科治疗研究的微创可复梗阻性黄疸模型的方法。方法健康版纳小型猪8头,随机分为对照组和模型组。对照组胆囊内置入改造的Foley尿管。模型组在胆道超选导丝引导下经胆囊内Foley尿管将胆道取石球囊导管由胆囊管送入胆总管。模型组于手术当天保持取石球囊空虚以造成胆道部分梗阻,于术后第2天充盈取石球囊以造成胆道完全梗阻,于术后4天撤除取石球囊导管以解除胆道梗阻。两组均于术后第2、4、6天行胆道造影检查,并取静脉血检测肝功生化指标。结果胆道造影显示模型组胆道部分梗阻时间段肝总管以上胆管明显扩张,壁光滑;胆道完全梗阻时间段肝内外胆管均扩张,壁光滑,尤以胆总管扩张明显,两者与对照组比较,均有显著性差异。胆道解除梗阻时间段肝内胆管未显影,胆总管未见扩张,壁光滑,与对照组比较无显著差异。模型组胆道部分梗阻时间段、完全梗阻时间段血清肝功生化指标较对照组显著增高;胆道解除梗阻时间段血清胆红素检查结果较梗阻时间段显著降低,但仍较对照组显著增高。结论利用胆道取石球囊导管成功地建立了适合进行内镜外科治疗研究的微创可复梗阻性黄疸模型,为梗阻性黄疸对机体多系统损害及其治疗的研究提供了可靠、简单且微创的实验方法。

Objective To reproduce an experimental model of microsurgical reversible obstruction jaundice by micro-surgical technique. Methods Eight Banna miniature pigs were equally and randomly assigned into model group and control group. An improved Foley catheter was put into gall bladder of the pigs in the control group. A biliary calculus removal balloon tube was inserted into the common bile duct through the cystic duct in the experimental group to establish either partial or total biliary obstruction. The obstruction could be relieved by withdrawing the balloon tube from the common bile duct. Biliary tract visualization was conducted to evaluate the biliary obstruction, and venous blood samples were collected to determine the liver function （such as serum levels of TBIL and ALT etc. ） in all pigs on the 2nd, 4th and 6th day after operation. Results Cholangiography showed a progressive dilation of both common hepatic duct and in trahepatic bile duct in the experimental group when the partial biliary obstruction was induced. During the periods when the total biliary obstruction was created the common bile duct, the common hepatic duct and intrahepafic bile duct of the animals in the experimental group were dilated progressively too. Both intra- and extra- hepatic bile ducts changed significantly compared to the control group. The dilatation subsided following the relief of obstruction. There was no dilatation of the bile duct in the control group. The serum levels of TBIL and ALT were significantly higher in the experimental group than that in the control group, and they were lowered after the relief of obstruction. Conclusion A microsurgical reversible obstruction jaundice model has been successfully reproduced with a biliary calculus removal balloon tube. It may provide a reliable experimental method for researches on the pothogenesis and treatment of obstruction jaundice.