CAJ | 학술논문

目的观察胆管梗阻性损伤后的病理学改变,为胆管修复手术时机的选择提供理论依据.方法建立家犬梗阻性胆管损伤模型,将60只家犬按照梗阻时间的长短分为胆管梗阻5 d组(BDL5组),胆管梗阻10 d组(BDL10组),胆管梗阻15 d组(BDL15组),胆管梗阻20 d组(BDL20组)和胆管梗阻30 d组(BDL30组),每组12只.由于对照组的取材不影响后期实验,即将BDL5组同时作为对照组.动态观察胆管梗阻性损伤后不同时间段内的胆管形态学和局部组织病理学的变化,并在相应时间内施行胆管空肠Roux-en-Y吻合术进行胆管修复,观察家犬胆管修复后的近期疗效.采用单因素方差分析、LSD法、独立样本t检验和x2检验分析数据.结果胆管梗阻性损伤后,近端胆管随着压力的增加而持续扩张,前期扩张迅速,BDL10组胆管扩张至(15.6±1.8)mm,后期扩张缓慢,BDL15组胆管扩张至(18.9±1.9)mm;损伤胆管局部组织出现急性炎症反应,BDL5组胆管炎症反应最重,单位面积的WBC数量达到(54±6)个,BDL15组胆管炎症反应明显减轻,单位面积的WBC数量为(42±7)个.两组比较,差异有统计学意义(t=4.688,P＜0.05).随着时间的延长,损伤胆管壁内的胶原含量不断增加.60只家犬中57只顺利完成胆管修复手术.术后10只家犬因发生胆汁漏死亡,其中BDL5组3只,BDL10组4只,其他组各1只;10 d内胆汁漏发生率为30%(7/23),10 d后胆汁漏发生率为9%(3/34),两者比较,差异有统计学意义(x2=4.429,P＜0.05).结论胆管梗阻性损伤10 d后,胆管扩张,局部组织及胆管炎性水肿明显减轻,手术操作难度较小,且术后家犬胆汁漏发生率低,故建议胆管梗阻性损伤10 d后再进行手术修复.
목적 관찰담관경조성손상후적병이학개변,위담관수복수술시궤적선택제공이론의거.방법 건립가견경조성담관손상모형,장60지가견안조경조시간적장단분위담관경조5 d조(BDL5조),담관경조10 d조(BDL10조),담관경조15 d조(BDL15조),담관경조20 d조(BDL20조)화담관경조30 d조(BDL30조),매조12지.유우대조조적취재불영향후기실험,즉장BDL5조동시작위대조조.동태관찰담관경조성손상후불동시간단내적담관형태학화국부조직병이학적변화,병재상응시간내시행담관공장Roux-en-Y문합술진행담관수복,관찰가견담관수복후적근기료효.채용단인소방차분석、LSD법、독립양본t검험화x2검험분석수거.결과 담관경조성손상후,근단담관수착압력적증가이지속확장,전기확장신속,BDL10조담관확장지(15.6±1.8)mm,후기확장완만,BDL15조담관확장지(18.9±1.9)mm;손상담관국부조직출현급성염증반응,BDL5조담관염증반응최중,단위면적적WBC수량체도(54±6)개,BDL15조담관염증반응명현감경,단위면적적WBC수량위(42±7)개.량조비교,차이유통계학의의(t=4.688,P＜0.05).수착시간적연장,손상담관벽내적효원함량불단증가.60지가견중57지순리완성담관수복수술.술후10지가견인발생담즙루사망,기중BDL5조3지,BDL10조4지,기타조각1지;10 d내담즙루발생솔위30%(7/23),10 d후담즙루발생솔위9%(3/34),량자비교,차이유통계학의의(x2=4.429,P＜0.05).결론 담관경조성손상10 d후,담관확장,국부조직급담관염성수종명현감경,수술조작난도교소,차술후가견담즙루발생솔저,고건의담관경조성손상10 d후재진행수술수복.
Objective To observe the pathological changes of tissues of the injured bile duct, and to provide theoretical basis for bile duct repair. Methods Dog models of obstructive biliary injury were established.Sixty dogs were equally divided into five groups according to the duration of biliary obstruction: biliary obstruction for 5 days (BDL5 group), 10 days (BDL10 group), 15 days (BDL15 group), 20 days (BDL20 group) and 30 days (BDL30 group). The morphological and pathological changes of bile duct and local tissues were observed, and biliary-enteric Roux-en-Y anastomosis was applied to repair the injured bile duct and postoperative complications were observed. All data were analyzed by LSD test, independent sample t test, one-way analysis of variance and chi-square test. Results Proximal bile duct rapidly expanded as the pressure increased in the early stage, and the bile duct expanded to ( 15.6 ± 1.8)mm in the BDL10 group. The expansion rate decreased in the later stage,and the bile duct expanded to (18.9 ± 1.9)mm in the B DL15 group. Acute inflammation was observed in injured local tissues. The acute inflammation was severe in the BDL5 group with white blood cell count of 54 ± 6, and the acute inflammation was relatively mild in the BDL15 group with white blood cell count of 42 ± 7. There was a significant difference between the BDL5 group and BDL15 group in the degree of acute inflammation (t =4. 688,P ＜ 0. 05). The content of the collagen was increased in the injured bile duct as time passed by. Bile duct repair was successfully performed on 57 dogs. Ten dogs ( three in the BDL5 group, four in the BDL10 group, one in the BDL15 group, one in the BDL20 group and one in the BDL30 group) died of bile leakage after the operation. The incidences of bile leakage was 30% (7/23) within 10 days and 9% (3/34) beyond 10 days, with a significant difference between the two groups (x2 =4.429, P＜0.05). Conclusion Ten days after obstructive biliary injury,an obvious reduction of bile duct expansion and edema of the bile duct is observed, the difficulty of the operation is reduced and the incidence of bile leakage is low, so 10 days after the incidence of obstructive biliary injury is the proper timing for the surgical repair.