损伤性胆管狭窄手术时机对肝功能变化影响的实验研究

Experimental Study on the Influence of Timing of Operation on the Changes of Hepatic Function in Patients with Traumatic Biliary Stricture

目的研究损伤性胆管狭窄手术时机对肝功能变化的影响。方法选取32只家兔,随机分为4组,每组8只。A组直接行胆管切断对端吻合术,B组胆管梗阻20 d、C组胆管梗阻30 d,D组胆管梗阻80 d,一期胆总管均置入橡皮塞,造成不完全性胆管梗阻,3个月后进行胆道再通及胆管对端吻合术,测定各组肝功能指标,对比肝功能变化情况。结果兔梗阻二期术前B、C、D组血清总胆红素(TBIL)、直接胆红素(DBIL)、谷丙转氨酶(ALT)、碱性磷酸酶(ALP)水平明显高于A组,且D组明显高于B、C组,差异有统计学意义(P<0.05);兔梗阻B、C组胆管修复术后7 d TBIL、DBIL、ALT、ALP水平明显恢复,D组恢复缓慢,差异有统计学意义(P<0.05);二期手术前各组动物模型扩张胆管壁胶原纤维含量均较A组增高,差异有统计学意义(P<0.05),二期术后B组与术前差异无统计学意义(P>0.05),C、D组明显下降,差异有统计学意义(P<0.05)。结论损伤性胆管狭窄手术,应遵循越早越好的原则,以促进肝功能的恢复,尽早进行胆管修复重建术,对肝功能损害小,肝功能恢复较快,具有重要的临床意义。

Objective To study the influence of the timing of surgery for traumatic biliary stricture on the changes of liver function.Methods 32 rabbits were selected and randomly divided into 4 groups with 8 in each.Group A underwent direct choledochotomy and end-to-end anastomosis.Group B had biliary obstruction for 20 d,group C had biliary obstruction for 30 d,group D had 80 d of obstruction,In one stage,rubber plug was inserted into the common bile duct,resulting in incomplete bile duct obstruction.After 3 months of operation,bile duct recanalization and cholangiostomy were performed to determine the liver function of each group.Results The levels of serum total bilirubin(TBIL),direct bilirubin(DBIL),alanine aminotransferase(ALT)and alkaline phosphatase(ALP)in groups B,C and D before operation were significantly higher than those in group A,group D was significantly higher than group B and C(P<0.05).Rabbits were obstructed by B,and the level of 7 d TBIL,DBIL,ALT,ALP after the repair of bile duct in group C was obviously restored,and the recovery of D group was slow,and the difference was statistically significant(P<0.05).The content of collagen fibers in dilated bile duct wall in each group was higher than that in group A before secondary operation,the difference was statistically significant(P<0.05),no statistically significant two B after operation compared with the preoperative difference(P>0.05),C and D group decreased significantly,the difference was statistically significant(P<0.05).Conclusion The surgical injury of bile duct stricture,should follow the principle as early as possible,in order to promote liver function can recover as soon as possible,bile duct reconstruction,less damage to liver function and liver function recovery,has important clinical significance.