胆总管末端金属支架植入对犬胆道压力影响的实验研究

An experimental study of impact on biliary pressure after stent implantation in distal common bile duct in dogs

目的:探讨胆总管末端金属支架植入后犬胆道压力的变化机制。材料与方法:随机选取成年实验犬6只,建立经皮经肝胆囊穿刺和胆总管末端植入金属支架的模型,并应用胆道测压的方法比较支架植入前后十二指肠压(Duodenalpressure,DP)、Oddi括约肌基础压(Sphincter of Oddi basal pressure,SOBP)、Oddi括约肌收缩幅度(Sphincter of Oddi contractive am-plitude,SOCA)、Oddi括约肌收缩间期(Sphincter of Oddi duration,SOD)以及胆总管压(Common bile duct pressure,CBDP)的变化。结果:6只实验犬全部一次穿刺成功,其中5只于观察时间内健康存活。以DP作为零点,获得其他各项指标的相对值。支架植入前SOBP、SOCA、SOD、CBDP分别为:(13.69±4.29)mmHg、(42.65±8.50)mmHg、(6.69±1.46)s、(12.98±2.86)mmHg;支架植入5周后分别为:(10.58±3.98)mmHg、(31.95±9.00)mmHg、(4.47±1.21)s、(7.43±2.20)mmHg,其中SOCA较支架植入前降低,SOD相比支架植入前缩短,两者均有统计学差异(P<0.05)。而CBDP明显低于支架植入前,具有显著的统计学差异(P<0.01)。结论:胆总管末端植入支架5周后,Oddi括约肌运动功能的减弱以紧张性收缩的减弱为主,而基础性收缩仍然存在。CBDP虽然下降,但仍高于正常的DP,并保持与之的压力梯度,从而为抑制肠胆返流提供了可能。

Objective：To discuss the mechanism on the changes of the biliary pressure after metallic stent placement in distal common bile duct in dogs.Materials and Methods：Six healthy adult dogs were randomly selected, and then an animal model was accomplished to implant the metallic stent in distal common bile duct through percutaneous transhepatic biliary puncture.With biliary manometry, measured results of duodenal pressure（DP）, sphincter of Oddi basal pressure（SOBP）, sphincter of Oddi contractive amplitude（SOCA）, sphincter of Oddi duration（SOD）, common bile duct pressure（CBDP） were compared before and after stent implantation of distal common bile duct.Results：All of the six dogs were successfully performed with biliary puncture and pressure measurement.Five dogs were healthy and survived during the observation.DP was regarded as a zero, and then the relative results were obtained.Before stent placement, the results of SOBP, SOCA, SOD, CBDP were（13.69±4.29）mmHg,（42.65±8.50）mmHg,（6.69±1.46）s,（12.98±2.86）mmHg respectively.After 5 weeks of stent implantation, the results of which were as follows,（10.58±3.98）mmHg,（31.95±9.00）mmHg,（4.47±1.21）s,（7.43±2.20）mmHg respectively.Compared with those before stent implantation, SOCA was lower and SOD was shortened, and there were significant differences（P0.05）.CBDP was significantly lower than that before stent implantation, and had statistically significant difference（P0.01）.Conclusion：After 5 weeks of stent implantation in distal common bile duct in dogs, the changes of sphincter of Oddi motor function is manifested mainly in the weakened phasic contraction, but there is still the basic contraction.Although descending, the CBDP is still higher than normal DP, and maintains with the pressure gradient to the duodenum.So it is possible to prevent duodenobiliary reflux.