犬胆管梗阻型损伤后不同时期胆管局部组织及全身生理机能的变化

Changes of physiological functions and local tissue of biliary stricture injury in different stages

目的通过动态观察胆管梗阻型损伤后不同时期胆管局部组织及全身生理机能的变化,探索梗阻型胆管损伤后手术修复干预的最佳时机。方法运用家犬制作梗阻型胆管损伤的动物模型,动态观察梗阻损伤后不同时间段内损伤胆管的形态学改变、局部组织炎性反应程度及阻塞性黄疸引起的机体肝功能指标的变化情况。结果胆管梗阻型损伤后,近端梗阻胆管在前期随着内压的急剧增高而扩张,梗阻第5天压力达到（39.83±3.05）cmH2O,胆管扩张至（9.2±1.8）mm,而后胆管内压力缓慢增加,胆管仍持续扩张,第15天达（18.91±1.85）mm;损伤胆管局部组织出现急性炎症反应,其中以5天组最严重,到第15天炎症消退明显,同时胆管壁由早期（第5天）的炎性水肿样增厚,改变成纤维增生性增厚（第15天）;在梗阻型黄疸状态下机体肝功能也发生规律性生理改变,表现在血清於胆指数TBIL、DBIL和ALP值在阻塞早期（BDL 5组）即达到最高,而后出现一个平台期,且轻度下降,至实验末期（BDL 30组）时出现极剧上升,酶学指标ALT和AST也出现类似改变,但梗阻第20天后出现轻度升高后再次下落,表现为＂胆酶分离＂现象。结论急性梗阻型胆管损伤后早期（10天）胆管扩张迅速,局部炎症水肿明显,肝功能损害,后期（20天后）肝脏功能出现失代偿,损伤胆管局部组织出现纤维化增生粘连,故认为犬梗阻型胆道损伤后10~20 d机体处于机能代偿期,局部炎性水肿减轻明显,该时期是手术处理的较好时机。

Objective To explore the optimal timing of operation for injurious biliary stricture（IBS） by observing dynamically changes of local tissue and systemic physiological function after biliary stricture injury in different stages.Methods Using dogs to establish the animal model of IBS,observe the changes of morphology and pathology of bile duct,and the liver function in different periods.Results After bile duct obstruction,the proximal bile duct dilated rapidly because of the increased bile duct pressure.The diameter of the bile duct dilated to（9.2±1.8） mm in the 5th day,and then to（18.91±1.85） mm in the 15th day.The injurious bile duct had the acute inflammation change.In the early time（in 10 days）,inflammatory cell infiltration increased,the mucous edema aggravated,the pipe wall dropsy accumulation,heaviest by the 5th day.In the later period（10-30 days）,inflammatory cell infiltration reduced,bile duct wall turned fibroplasias by the inflammatory edema,obviously in the 15th days.During the biliary obstruction,the liver function showed that the bilirubin reached the highest level in the early（BDL5 group）,then presented a platform time,even mild setback,and then rised extremely in the last stage of the experiment（BDL30 group）,the similar changes was also appeared in the enzyme indexes ALT and AST.It appeared a decline after a mild rise at the 20th day of obstruction and showed the phenomenon of bilirubin-enzyme separation.Conclusion Acute obstruction of bile duct injury in the early（10 days） can lead to the rapid increase in bile duct dilatation,hepatic dysfunction,local inflammation and edema of bile duct damage,followed by compensatory changes in the body there,20 days after the liver decompensation occurs,while bile duct damage local tissue shows fibrosis of hyperplasia adhesion,so we thinks the period between 10 and 20 days after acute bile duct injury is good time for the surgery.