乙酸消融胆道的实验研究

Preliminary screening of acetic acid for selective bile duct ablation and embolization

目的探讨乙酸消融家兔胆道后病理及肝功改变,为临床应用消融栓塞胆道治疗肝内胆管结石提供实验依据。方法观察家兔右外叶胆道于25%至5%浓度乙酸消融后肝脏功能状态、肝组织病理改变和术后存活情况。结果25%乙酸胆道消融造成右外叶肝脏大块坏死,仅肝叶边缘有少量存活肝组织。20%乙酸胆道消融后近肝门部肝实质以汇管区为中心的坏死,肝叶中部见汇管区及周围少量肝细胞坏死,肝叶边缘见汇管区点状坏死。15%乙酸胆道消融后近肝门部见汇管区及周围少量组织坏死,肝叶中部及边缘组织见胆管无明显改变,周围组织点状坏死。10%乙酸胆道消融后近肝门部汇管区胆管坏死,周围充血,肝叶中部胆管上皮完整,周围组织充血,肝叶边缘胆管完整,周围少量肝细胞肿胀。5%乙酸胆道消融后近肝门部胆管上皮坏死,肝叶中部胆管上皮完整,仅充血或少量肝细胞肿胀。结论20%为乙酸消融胆道较理想的浓度。

Objective To study pathological changes after ablation with acetic acid in intrahepatic bile ducts in rabbits.Methods Thirty rabbits were divided into group A（25% acetic acid,n=6）,group B（20% acetic acid,n=6）,group C（15% acetic acid,n=6）,group D（10% acetic acid,n=6）,group E（5% acetic acid,n=6）.The hepatic histopathology and the survival rate of the rabbits were observed.Results In group A,right external lobe liver was barely completely necrosis after ablation with 25% acetic acid.There was only a few of normal liver tissues remain at the edge of liver lobe.In group B,portal area tissues and some liver cells nearby were necrosis near porta hepatis.In the middle and at the edge of lobe,portal areas were necrosis.In group C,portal area tissues and a few of liver cells nearby were necrosis near porta hepatis.In the middle and at the edge of lobe,there were no obviously changes in the introhepatic bile ducts.In group D,the introhepatic bile ducts near porta hepatis were necrosis and portal areas were congested.In the middle of lobe were congested.The biliary tracts were normal at the edge of lobe and there were not obviously hepatic tissues necrosis.In group E,the epithelia of bile ducts near porta hepatis were necrosis.In the middle of the lobe or at the edge,there were some liver cells swelling.Conclusions 20% is the proper concentration of acetic acid for selective bile duct ablation.