Oddi括约肌功能异常在兔肝内胆管结石形成中的作用

Role of functional abnormality of sphincter of Oddi on formation of intrahepatic calculi in rabbits

目的探讨Oddi括约肌(Sphincter of Oddi,SO)功能异常与肝内胆管结石形成的关系。方法建立家兔肝内胆管结石模型,成年家兔(n=64)随机分为对照组(n=16)和实验组(n=48),实验组再分为2周,4周,8周组(每组n=16),比较各组胆汁性状及成石率,测定SO肌电,透射电镜观察SO超微结构。结果8周组家兔成形结石形成率(68.75%,11/16)显著高于4周组(12.50%,2/16)和2周组(0.00%,0/16);肌电测定提示:与对照组比较,实验组SO肌电峰值逐渐减低,频率逐渐减慢。电镜超微结构表现:对照组及2周组SO无变性;实验组4周和8周组SO肌纤维溶解、胶原增多,微丝融合、增粗,致密斑减少、排列紊乱,线粒体、内质网肿胀,核周间隙增宽、核偏移及核固缩,胞质中髓样包涵体形成。其变性程度8周组>4周组。结论SO运动功能异常与肝内胆管结石形成存在密切联系,两者互为因果。SO肌纤维变性是其运动功能异常的病理基础。

Objective To investigate the relationship between motor abnormality of sphincter of Oddi （ SO ） and hepatofithiasis. Methods The hepatolithiasis rabbit models were established in adult rabbits （ n = 64 ） which were randomly divded into 2 groups ： control group （ n = 16 ） and experimental group （ n = 48 ） , including 2 wk, 4 wk and 8 wk group （ n = 16 per group ）. During the formation process of hepatolithiasis, bile character and ratio of stone formation were both observed, then the myoeleetrie waves of SO were recorded. Finally, The SO segment was sliced and observed by transmissional electron microscope. Results The rate of true stone formation in group 8 wk （68. 75% , 11/16 ） was higher than that in group 4wk （12.50% ,2/16）and in group 2wk （0. 00% ,0/16）. Compared with the control group, there was significant decrease of both SO myoelectric peak amplitude and SO myoeleetric frequency in the experimental group. Electron microscopy showed that SO cells in control group and 2 wk group had no change, but the 4 wk and 8 wk groups underwent changes including fibrolysis of myofilament, increase of collagen fibers, fusion and thickening of mierofilament, decrease and array disorder of macula densa, swelling of ehondrusomc and endoplasmic reticulum, widening of perinuclear space and deviation and pyknosis of nucleus, and formation of inclusion body in cytoplasm ; and the degeneration degree in 8 wk group was obvious than that in group 4 wk Conclusions The functional abnormality of SO may contribute important effects on the formation of hepatolithiasis Fibrous degeneration of SO maybe the pathogenesis of functional abnormality of SO.