CAJ | 학술논문

目的研究胆道系统不同部位胆管上皮细胞的异质性以及胆管周围血管丛构筑形式的不同,对缺血再灌注损伤耐受性的差异.方法 30只SD大鼠随机分成3组,Ⅰ组(假手术组),Ⅱ组(胆道缺血1 h再灌注1 h组),Ⅲ组(胆道缺血1 h再灌注2 h组).对肝门部胆管、胆总管近端及小叶间胆管的上皮细胞行凋亡(TUNEL法)检测、病理形态学评分和超微结构的定量分析.结果 Ⅱ组的细胞凋亡及病理形态评分在胆总管近端与小叶间胆管无统计学差异(P＞0.05),但肝门部损伤较重(P＜0.05);线粒体平均体积(V)及微绒毛面积密度(AMv)比较在肝门部最重,胆总管近端最轻(P＜0.05).在Ⅲ组以上各指标都表现为肝门部最重,小叶间胆管次之,胆总管近端最轻(P＜0.05).结论胆管上皮细胞的异质性以及周围血管丛不同部位构筑形式的不同导致了胆道系统各部位损伤程度的差异.该结果为解释肝门部胆管狭窄高发率的临床表现提供了一定的实验基础.胆总管近端损伤最轻这一结果提示,在临床肝移植中,应尽量以胆总管近端作为最佳吻合部位.
목적 연구담도계통불동부위담관상피세포적이질성이급담관주위혈관총구축형식적불동,대결혈재관주손상내수성적차이.방법 30지SD대서수궤분성3조,Ⅰ조(가수술조),Ⅱ조(담도결혈1 h재관주1 h조),Ⅲ조(담도결혈1 h재관주2 h조).대간문부담관、담총관근단급소협간담관적상피세포행조망(TUNEL법)검측、병리형태학평분화초미결구적정량분석.결과 Ⅱ조적세포조망급병리형태평분재담총관근단여소협간담관무통계학차이(P＞0.05),단간문부손상교중(P＜0.05);선립체평균체적(V)급미융모면적밀도(AMv)비교재간문부최중,담총관근단최경(P＜0.05).재Ⅲ조이상각지표도표현위간문부최중,소협간담관차지,담총관근단최경(P＜0.05).결론 담관상피세포적이질성이급주위혈관총불동부위구축형식적불동도치료담도계통각부위손상정도적차이.해결과위해석간문부담관협착고발솔적림상표현제공료일정적실험기출.담총관근단손상최경저일결과제시,재림상간이식중,응진량이담총관근단작위최가문합부위.
Objective To comparatively study the ischemia-reperfusion injuries caused by heterogeneity of different positions of the biliary system and different construction patterns of the peribiliary vascular plexus. Methods Thirty rats were randomly divided into 3 groups: Group Ⅰ , sham operated; Group Ⅱ , 1h ischemia in biliary tract followed by 1h reperfusion; Group Ⅲ, 1h ischemia in biliary tract followed by 2h reperfusion. TUNEL assay, pathomorphology score determination and ultrastructural quantitative analysis were performed on epithelium of the hilar bile duct, proximal common bile duct and interlobular bile duct. Results In groupⅡ , TUNEL assay and pathomorphology score showed no statistical difference between proximal common bile duct and interlobular bile duct (P＞0.05) but showed significant differences in the hilar bile duct(P＜0.05). Mean volume (V) of mitochondria and area density of microvilli were obviously serious in the hilar bile duct but obviously slight in the proximal common bile duct(P＜0. 05). In group Ⅲ, the results of the above detections showed that the most severe was in hilar bile duct, followed by the interlobular bile duct and proximal common bile duct(P＜0. 05). Conclusion Different injuries in various parts of the biliary system are caused by heterogeneity of biliary epithelial cells and construction patterns of the peribiliary vascular plexus. It also provides the experimental basis to explain the higher incidences of hilar bile duct stricture. It could be taken as the best position when the bile duct is anastomosed.