CAJ | 학술논문

目的探讨实验性梗阻性胆道损伤后手术修复的时机.方法将60只健康家犬制成梗阻性胆管损伤的动物模型,随机分为5组(n=12),分别为梗阻5 d,梗阻10 d,梗阻15 d、梗阻20 d和梗阻30 d组,对照组为模型建立之前的正常犬.动态观察梗阻损伤后不同时间段的胆管形态学、局部组织病理学及肝脏功能变化指标,并于各组获得组织标本后即刻行胆肠Roux-en-Y吻合修复胆道,观察胆道梗阻性损伤修复术后犬并发症及生存情况.数据采用单因素方差分析进行分析.结果胆管梗阻性损伤后,近端梗阻胆管持续扩张,第10天达(15.6±1.7)mm;损伤胆管局部组织出现急性炎症反应,以梗阻5 d时最严重(HE染色、WBC计数54±6个),梗阻第15天时炎症消退明显(HE染色、WBC计数42±7 vs 54±6个,P＜0.05),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);在梗阻性黄疸状态下肝功能发生规律性生理改变,血清TBIL、DBIL和ALP值在阻塞5 d组最高,至梗阻30 d时急剧上升(P＜0.05);而酶学指标ALT和AST在迅速升高后,在梗阻20 d后下降(P＜0.05),表现为"胆酶分离"现象;其中57只犬成功经受胆道修复手术,10只犬术后10 d内因胆漏死亡,其中损伤10 d内修复的胆漏7只,损伤10 d后修复的胆漏3只(P=0.025),术后观察发现,梗阻性损伤后3个月内营养及脏器衰竭死亡13例,其中梗阻5 d和梗阻10 d组各1例,梗阻15 d和20 d组各2例,梗阻30 d组7例(P＜0.05).结论胆道梗阻后10～20 d机体处于代偿期,且炎性水肿减轻明显,手术操作难度较小,此时行手术修复,胆漏发生率和器官衰竭率较低,手术容易获得良好效果.
목적 탐토실험성경조성담도손상후수술수복적시궤.방법 장60지건강가견제성경조성담관손상적동물모형,수궤분위5조(n=12),분별위경조5 d,경조10 d,경조15 d、경조20 d화경조30 d조,대조조위모형건립지전적정상견.동태관찰경조손상후불동시간단적담관형태학、국부조직병이학급간장공능변화지표,병우각조획득조직표본후즉각행담장Roux-en-Y문합수복담도,관찰담도경조성손상수복술후견병발증급생존정황.수거채용단인소방차분석진행분석.결과 담관경조성손상후,근단경조담관지속확장,제10천체(15.6±1.7)mm;손상담관국부조직출현급성염증반응,이경조5 d시최엄중(HE염색、WBC계수54±6개),경조제15천시염증소퇴명현(HE염색、WBC계수42±7 vs 54±6개,P＜0.05),동시담관벽유조기(제5천)적염성수종양증후,개변성섬유증생성증후(제15천);재경조성황달상태하간공능발생규률성생리개변,혈청TBIL、DBIL화ALP치재조새5 d조최고,지경조30 d시급극상승(P＜0.05);이매학지표ALT화AST재신속승고후,재경조20 d후하강(P＜0.05),표현위"담매분리"현상;기중57지견성공경수담도수복수술,10지견술후10 d내인담루사망,기중손상10 d내수복적담루7지,손상10 d후수복적담루3지(P=0.025),술후관찰발현,경조성손상후3개월내영양급장기쇠갈사망13례,기중경조5 d화경조10 d조각1례,경조15 d화20 d조각2례,경조30 d조7례(P＜0.05).결론 담도경조후10～20 d궤체처우대상기,차염성수종감경명현,수술조작난도교소,차시행수술수복,담루발생솔화기관쇠갈솔교저,수술용역획득량호효과.
Objective To explore the optimal timing of operation for experimental obstructive jaundice in a dog model. Method A dog model of bile duct stricture (BDS) was established. Dogs were divided into (n = 12 in each group) 6 groups, ie control, BDS days 5, 10, 15, 20, and 30. In each dog,the morphology and local histopathology of the bile duct, and the liver function in different periods were observed. At the time of surgery biopsy was taken and Roux-en-Y hepaticojejunostomy performed. Surgical complications and survival were evaluated. Result After bile duct obstruction, the proximal bile duct dilated continuously. The diameter of bile duct was 15.6 ± 1.7 mm at the 10th day. The injury bile ductshowed the acute inflammation change. In the early time (in 10 days), inflammatory cells increased in the tissues, mucous edema aggravated, the wall was edematous thickening, it was most severe ( WBC counting 54 ±6) in the 5th day. In the later period (10 -30 days), inflammatory cells reduced, bile duct wall became fibrosis, which was most obvious in the 15th day (42 ± 7 vs 54 ± 6, P ＜ 0.05 ). During the development of jaundice, serum bilirubin reached the highest level in the early period ( BDS days 5 group),then presented a platform time, and then rised extremely at the last stage of the experiment ( BDS day 30 group) . Changes of ALT and AST paralleled that of bilirubin before the 20th day of obstruction and then plummeted. BDS was repaired successfully in 57 dogs. Ten dogs died postoperatively due to bile leakage within 10 days, 3 dogs in BDS days 5 group (3/11), 4 in BDS days 10 group (4/12), one each in other groups. Postoperatively 13 BDS dogs died of malnutrition and organ failure within 3 months, including one each in days 5 and days 10 group, two each in days 15 and days 20 group, and 7 in days 30 group (P＜0. 05). Conclusion Considering the changes of morphology, physical function and result of follow up.The period between 10 and 20 days after acute bile duct injury is optimal for surgical repair.