大鼠梗阻性黄疸自然消退的原因和手术减黄时间的研究

Causes of natural regression of obstructive jaundice in rats and time for surgery to reduce yellowing

目的探讨大鼠梗阻性黄疸自然消退的原因,为合理选择实验模型和减黄手术的时间提供依据。方法大鼠54只,随机分为胆总管结扎离断组(A组),胆总管单纯结扎组(B组)及对照组(C组),每组18只。术后第1、3、7、14、21天检测血清总胆红素(TBIL)和丙氨酸氯基转移酶(ALT),第21天行泛影葡胺行胆管造影,第28天行胆管核素显像,各组间及组内实验室结果比较采用单因素方差分析。结果术后1 d A组和B组TBIL开始升高,第7天为高峰。术后14 d两组黄疸开始分离,A组3只(16.7%)大鼠TBIL和ALT下降,B组14只(77.8%)大鼠开始下降,A、B两组比较[(136.5±14.3)μmol/L比(78.5±12.8)μmol/L,t=196.203,P<0.05],术后21 d A组及B组下降者基本降至正常水平,ALT也有相同规律(t=57.450,P<0.05)。术后21 d泛影葡胺行胆管造影,A组可见结扎线以上胆管明显扩张,造影剂未向其他部位扩散;B组近侧胆管稍有扩张,见造影剂经肝门部粘连网膜管道进入肠腔。术后28 d近侧扩张胆管核素显像与定量,A组大鼠未见核素排入肠道,B组大鼠5 min后见核素由肝脏经肝门部粘连网膜开始排入肠道、出现核素显影。结论大鼠梗阻性黄疸模型存在自然消退情况,可能是肝门部存在微小的胆管或粘连的网膜管道分流所致,做胆道梗阻模型时应首选胆总管离断,减黄干预可选择建模14d后进行。

Objective to investigate the causes of spontaneous resolution of obstructive jaundice in rats,and to provide theoretical basis for rational selection of experimental model and duration of yellow reduction surgery.Methods 54 rats were randomly divided into the bile duct ligation and dissociation group(group A),the bile duct ligation group(group B)and the control group(group C),with 18 rats in each group.Serum total bilirubin(TBIL)and alanine aminotransferase(ALT)were detected on the first,3,7,14 and 21 d after the operation,cholangiography was performed on the 21d with meglumine diatrizoate,and bile duct radionuclide imaging was performed on the 28 d.One-way anova was used to compare the laboratory results between groups and within groups.Results TBIL increased in group 1dA and group B,and peaked on day 7.On the 14th day after the operation,the icterus began to be separated from the two groups,3(16.7%)rats in group A and 14(77.8%)rats in group B began to decline,and the comparison between groups A and B[(136.5±14.3)mumol/L ratio(78.5±12.8)mumol/L,t=196.203,P<0.05].After the operation,those in group 21dA and group B basically returned to normal level,and ALT showed the same rule(t=57.450,P<0.05).21 d after the operation,cholangiography was performed with meglumine diatrizoate.The bile ducts above the ligation line were significantly dilated in group A,and the contrast agent did not spread to other sites.In group B,the proximal bile duct was slightly dilated,and contrast agent was observed to enter the intestinal cavity through the adhesion omentum duct at the hilum of liver.Radionuclide imaging and quantification of the proximal dilated bile duct 28 days after the operation,no radionuclide was discharged into the intestinal tract in the rats in group A,while the radionuclide was discharged into the intestinal tract from the liver through the attached omentum at the hilar of the liver in the rats in group B after 5min,and the radionuclide was developed.Conclusion the spontaneous resolution of obstructive jaundice in rats may be caused by the presence of small bile duct or adhesive retinal duct shunt in the hepatic hilum.Bile duct rupture should be the first choice for biliary obstruction model,and yellow reduction intervention can be conducted after modeling for 14 d.