医源性肝外胆管结扎时间对胆管损伤程度的实验研究

The experimental study of time of iatrogenic extrahepatic bile duct ligation led to degree of bile duct injury

目的探讨医源性肝外胆管结扎时间对胆管损伤后狭窄程度的影响。方法选取家兔46只,空白对照组10只(A组);建立家兔肝外胆管结扎动物模型36只,随机分为结扎1天组(B组)、3天组(C组)、7天组(D组),每组12只,结扎期满后每组处死半数,剩余半数行结扎线松解,松解后3个月处死。全部实验动物不同时期取血观察其肝功能的变化;胆管、肝脏取材光镜下观察病理变化及胆管胶原含量的变化。结果结扎7天组2例二期手术松解后肝功能无好转,持续黄疸死亡,1例松解后3个月取材时发现胆管结扎线处有硬化狭窄存在;存活结扎组二期手术松解后肝功能都得以恢复,未发生梗阻;随着结扎时间的延长,胆管逐渐扩张、增厚,炎症水肿加重,胆管壁胶原含量增加,结扎1天肝脏即出现坏死灶,结扎7天可出现肝纤维化。结论胆管结扎7天可引起远期胆管狭窄硬化、胆道梗阻;应尽早行手术治疗。

Objective To explore the impact about time of iatrogenie extrahepatie bile duet ligation led to degree of narrow after bile duet injury. Methods Select rabbits 46, control group 10 （ group A） ;The rabbit animal model of extrabepatie bile duet ligation was established. 36 were randomly divided into ligation one day group （group B） ,three days （group C） ,7 days （group D）. There are 12 each group, half of each group were sacrificed when the time of ligation was the expiry, half of the remaining released ligation line, three months later,they were executed. All laboratory animals observed their blood changes in liver function in different periods. After obtaining duet and liver,their pathological changes and bile duet collagen content changes were observed in the light microscope. Results Two eases of ligation seven days group died beeanse their liver function didn＇ t improve and continue jaundice, one ease of release occurred sclerosis narrow after three months later; Liver fimetion of survival ligation group restored after release, and didn＇t occur obstruc- tion. With the extension of the time of bile duet ligation, bile duet gradual expansion, thickening, and inflammatory edema increased ,bile duet wall collagen content increased. Liver necrosis lesions after ligation one day, hepatic fibrosis after ligation seven days. Conclusions Bile duet after ligation seven days can cause long - term biliary stricture sclerosis, biliary obstruction; It should be surgical treatment as early as possible.