CAJ | 학술논문

目的：建立一种能简便实行胆汁内外引流的可逆型梗阻性黄疸兔模型。方法：新西兰大白兔36只，随机分为3组，胆汁外引流组(A组，n=12)、胆汁内引流组(B组，n=12)及假手术组(C组，n=12)。 A、B组采用切断胆总管后分别向肝与十二指肠方向插入硅胶管，两端缝扎固定，夹闭器夹闭硅胶管并缝于皮下的方法建立可逆型梗阻性黄疸模型，造模后第7天再次手术，剪断硅胶管引至体外形成胆汁外引流，去除夹闭器后恢复胆汁内引流；C组采用分离胆总管后打松结的方法作为对照。所有兔于造模前、造模后第7天、再次手术后第7天时采血检测肝功能指标，B超检查肝胆系统；再次手术后第7天取肝脏组织标本作病理学检查。结果：成功建立了可逆型梗阻性黄疸模型。造模前A、B、C3组间总胆红素(total bilirubin，TB)、直接胆红素(direct bilirubin，DB)、谷丙转氨酶(alanine transarninase，ALT)、γ-谷氨酰转肽酶(γ-glu-tamyl transferase，γ-GT)差异无统计学意义(均P>0.05)；造模后第7天A、B两组TB、DB、ALT、γ-GT较造模前明显增高(均P<0.05)，明显高于C组(P<0.05)；再次手术后第7天A、B两组TB、DB、ALT、γ-GT较造模后第7天明显下降(P<0.05)， A、B、C 3组间差异无统计学意义(P>0.05)。造模后第7天，B超下可见A、B两组肝脏弥漫性肿大，胆囊增大，肝内胆管、肝总管明显扩张；再次手术后第7天，B超下可见A、B两组肝脏无明显肿大，胆囊萎缩，肝内胆管、肝总管无明显扩张。再次手术后第7天，A组肝小叶结构基本恢复正常，肝窦轻度扩大，汇管区少量炎症细胞浸润伴纤维组织增生；B组汇管区无明显炎症细胞浸润。结论：研究建立的可逆型梗阻性黄疸模型具有可靠有效，可重复性强，再通时操作简单等特点，值得在梗阻性黄疸和胆汁内外引流实验中推广。
목적：건립일충능간편실행담즙내외인류적가역형경조성황달토모형。방법：신서란대백토36지，수궤분위3조，담즙외인류조(A조，n=12)、담즙내인류조(B조，n=12)급가수술조(C조，n=12)。 A、B조채용절단담총관후분별향간여십이지장방향삽입규효관，량단봉찰고정，협폐기협폐규효관병봉우피하적방법건립가역형경조성황달모형，조모후제7천재차수술，전단규효관인지체외형성담즙외인류，거제협폐기후회복담즙내인류；C조채용분리담총관후타송결적방법작위대조。소유토우조모전、조모후제7천、재차수술후제7천시채혈검측간공능지표，B초검사간담계통；재차수술후제7천취간장조직표본작병이학검사。결과：성공건립료가역형경조성황달모형。조모전A、B、C3조간총담홍소(total bilirubin，TB)、직접담홍소(direct bilirubin，DB)、곡병전안매(alanine transarninase，ALT)、γ-곡안선전태매(γ-glu-tamyl transferase，γ-GT)차이무통계학의의(균P>0.05)；조모후제7천A、B량조TB、DB、ALT、γ-GT교조모전명현증고(균P<0.05)，명현고우C조(P<0.05)；재차수술후제7천A、B량조TB、DB、ALT、γ-GT교조모후제7천명현하강(P<0.05)， A、B、C 3조간차이무통계학의의(P>0.05)。조모후제7천，B초하가견A、B량조간장미만성종대，담낭증대，간내담관、간총관명현확장；재차수술후제7천，B초하가견A、B량조간장무명현종대，담낭위축，간내담관、간총관무명현확장。재차수술후제7천，A조간소협결구기본회복정상，간두경도확대，회관구소량염증세포침윤반섬유조직증생；B조회관구무명현염증세포침윤。결론：연구건립적가역형경조성황달모형구유가고유효，가중복성강，재통시조작간단등특점，치득재경조성황달화담즙내외인류실험중추엄。
Objective: To establish a reversible rabbit model of obstructive jaundice which was easy to execute internal and external biliary drainage. Methods:36 New Zealand rabbits were randomly divided into three groups:external biliary drainage group(group A), internal biliary drainage group(group B) and sham operation group(group C). In groups A, B, reversible rab-bit model of obstructive jaundice was established, including cutting off common bile duct, putting silica gel duct in hepatic and duodenal ends, fixing both ends by suturing, occluding silica gel duct and then subcutaneously sewing. Rabbits were subjected with operation again at the 7th day postoperatively: external biliary drainage was formed by shearing off silica gel duct and puting vitro, and internal biliary drainage was formed by removing occlusion. In sham operation group, rabbits were subjected with liberating common bile duct and making loose knot. Blood of all animals was collected preoperatively , at 7th day postoperatively and 7th day after second operation. Liver function was detected by automatic biochemistry analyzer. Liver and bile duct were observed by ultrasound postoperatively and at 7th day postoperatively and 7th day after second operation. Liver tissue was collected at 7th day after second operation , and the pathology of liver was observed. Results: The reversible rabbit model of obstructive jaundice was established. There was no significant difference in liver function of groups A, B, C postoperatively. The level of total bilirubin (TB), direct bilirubin (DB), alanine transarninase(ALT) andγ-glutamyl transferase (γ-GT) were higher in groups A, B than those in groups A, B preoperatively and group C at 7th day postoperatively. At 7th day after second operation, the level of TB, DB, ALT and γ-GT after internal and external drainage in groups A, B were decreased, and there was no significant difference in groups A, B, C. It was shown that liver enlarged diffusely, gallbladder enlarged, intra-hepatic and common hepatic duct expanded significantly in groups A, B compared with group C by ultra-sound at 7th day postoperatively, while liver enlarged unconspicuously, gallbladder atrophied, intra-hepatic and common hepatic duct expanded unconspicuously at 7th day after second operation. Meanwhile , it was shown that structure of hepatic lobular recovered basically, hepatic sinus expanded mildly, a few inflammatory cells infiltrated portal area with hyperplasia of fibrous tissue in group A compared with group C, while no inflammatory cell infiltrated portal area in group B at 7th day after second operation. Conclusion: The reversible model of obstructive jaundice had great advantages for it was simple, reliable, effective and repeatable.