中华实验外科杂志
中華實驗外科雜誌
중화실험외과잡지
CHINESE JOURNAL OF EXPERIMENTAL SURGERY
2014年
6期
1273-1276
,共4页
T管窦道%胆道探查%家兔
T管竇道%膽道探查%傢兔
T관두도%담도탐사%가토
T-tube sinus%Bile duct exploration%Rabbit
目的 在建立家兔模拟腹腔镜T管置入模型上,观察纱布块沾拭对家兔T管窦道形成的影响.方法 取健康成年雄性新西兰白兔72只,随机分为正常组、腹腔镜组、腹腔镜纱布沾拭组3组,每组24只,建立家兔模拟腹腔镜T管置入模型.分别于造模后3、7、14 d,每组随机取8只.耳缘静脉采血,分离血浆,并用酶联免疫吸附试验(ELISA)法检测血浆中转化生长因子-β1(TGF-β1)、白细胞介素-6(IL-6)及纤维蛋白原(Fib)的含量.然后断颈处死兔,开腹:(1)肉眼观察术后肠粘连程度;(2)观察窦道形成;(3)开腹取材,取粘连肠壁组织0.5 cm ×0.5 cm;若无粘连形成,在距回盲部5 cm处取肠管0.5 cm ×0.5 cm,行中性福马林溶液固定、石蜡包埋、厚4μm连续切片,用免疫组织化学染色法检测肠管组织中基质金属蛋白酶-1(MMP-1)、基质金属蛋白酶-1抑制剂(TIMP-1)的活性.结果 (1)各组家兔血浆中TGF-β1、IL-6及Fib的含量在术后第3天达到高峰(6.21 ±0.68、9.17±2.32、9.78 ±2.75),随时间的延长含量逐渐下降,至术后14 d接近正常水平(4.07±1.57、7.67±2.42、8.01 ±1.92),而且各时间点腹腔镜组及纱布块沾拭组血浆中TGF-β1、IL-6及Fib的含量均较正常组明显升高(P＜0.01).但在同一时间点腹腔镜组家兔血浆中TGF-β1、IL-6、Fib的含量与纱布块沾拭组比差异无统计学意义(P＞0.05).(2)各时间点纱布块沾拭组肠壁组织中MMP-1、TIMP-1活性均明显高于腹腔镜组及正常组(37.42±5.26、67.41 ±5.18比32.46±8.76、52.46±6.81,P＜0.05).(3)纱布块沾拭组各时间点家兔肠粘连程度及窦道形成均明显高于腹腔镜组(P＜0.05).结论 纱布块沾拭可以促进TGF-β1、IL-6等炎性因子的释放,增加血浆中Fib的浓度,激活组织中TIMP-1的活性,从而促进腹腔粘连及T管窦道的形成.
目的 在建立傢兔模擬腹腔鏡T管置入模型上,觀察紗佈塊霑拭對傢兔T管竇道形成的影響.方法 取健康成年雄性新西蘭白兔72隻,隨機分為正常組、腹腔鏡組、腹腔鏡紗佈霑拭組3組,每組24隻,建立傢兔模擬腹腔鏡T管置入模型.分彆于造模後3、7、14 d,每組隨機取8隻.耳緣靜脈採血,分離血漿,併用酶聯免疫吸附試驗(ELISA)法檢測血漿中轉化生長因子-β1(TGF-β1)、白細胞介素-6(IL-6)及纖維蛋白原(Fib)的含量.然後斷頸處死兔,開腹:(1)肉眼觀察術後腸粘連程度;(2)觀察竇道形成;(3)開腹取材,取粘連腸壁組織0.5 cm ×0.5 cm;若無粘連形成,在距迴盲部5 cm處取腸管0.5 cm ×0.5 cm,行中性福馬林溶液固定、石蠟包埋、厚4μm連續切片,用免疫組織化學染色法檢測腸管組織中基質金屬蛋白酶-1(MMP-1)、基質金屬蛋白酶-1抑製劑(TIMP-1)的活性.結果 (1)各組傢兔血漿中TGF-β1、IL-6及Fib的含量在術後第3天達到高峰(6.21 ±0.68、9.17±2.32、9.78 ±2.75),隨時間的延長含量逐漸下降,至術後14 d接近正常水平(4.07±1.57、7.67±2.42、8.01 ±1.92),而且各時間點腹腔鏡組及紗佈塊霑拭組血漿中TGF-β1、IL-6及Fib的含量均較正常組明顯升高(P＜0.01).但在同一時間點腹腔鏡組傢兔血漿中TGF-β1、IL-6、Fib的含量與紗佈塊霑拭組比差異無統計學意義(P＞0.05).(2)各時間點紗佈塊霑拭組腸壁組織中MMP-1、TIMP-1活性均明顯高于腹腔鏡組及正常組(37.42±5.26、67.41 ±5.18比32.46±8.76、52.46±6.81,P＜0.05).(3)紗佈塊霑拭組各時間點傢兔腸粘連程度及竇道形成均明顯高于腹腔鏡組(P＜0.05).結論 紗佈塊霑拭可以促進TGF-β1、IL-6等炎性因子的釋放,增加血漿中Fib的濃度,激活組織中TIMP-1的活性,從而促進腹腔粘連及T管竇道的形成.
목적 재건립가토모의복강경T관치입모형상,관찰사포괴첨식대가토T관두도형성적영향.방법 취건강성년웅성신서란백토72지,수궤분위정상조、복강경조、복강경사포첨식조3조,매조24지,건립가토모의복강경T관치입모형.분별우조모후3、7、14 d,매조수궤취8지.이연정맥채혈,분리혈장,병용매련면역흡부시험(ELISA)법검측혈장중전화생장인자-β1(TGF-β1)、백세포개소-6(IL-6)급섬유단백원(Fib)적함량.연후단경처사토,개복:(1)육안관찰술후장점련정도;(2)관찰두도형성;(3)개복취재,취점련장벽조직0.5 cm ×0.5 cm;약무점련형성,재거회맹부5 cm처취장관0.5 cm ×0.5 cm,행중성복마림용액고정、석사포매、후4μm련속절편,용면역조직화학염색법검측장관조직중기질금속단백매-1(MMP-1)、기질금속단백매-1억제제(TIMP-1)적활성.결과 (1)각조가토혈장중TGF-β1、IL-6급Fib적함량재술후제3천체도고봉(6.21 ±0.68、9.17±2.32、9.78 ±2.75),수시간적연장함량축점하강,지술후14 d접근정상수평(4.07±1.57、7.67±2.42、8.01 ±1.92),이차각시간점복강경조급사포괴첨식조혈장중TGF-β1、IL-6급Fib적함량균교정상조명현승고(P＜0.01).단재동일시간점복강경조가토혈장중TGF-β1、IL-6、Fib적함량여사포괴첨식조비차이무통계학의의(P＞0.05).(2)각시간점사포괴첨식조장벽조직중MMP-1、TIMP-1활성균명현고우복강경조급정상조(37.42±5.26、67.41 ±5.18비32.46±8.76、52.46±6.81,P＜0.05).(3)사포괴첨식조각시간점가토장점련정도급두도형성균명현고우복강경조(P＜0.05).결론 사포괴첨식가이촉진TGF-β1、IL-6등염성인자적석방,증가혈장중Fib적농도,격활조직중TIMP-1적활성,종이촉진복강점련급T관두도적형성.
Objective To assess the effect of gauze piece scrub on rabbit T-tube sinus formation using an established rabbit model of laparoscopic T tube.Methods Seventy-two male rabbits were randomly divided into sham,laparoscopy,and laparoscopic gauze piece scrub groups (n =24),and assessed at 3rd,7th and 14th day respectively after molding.Enzyme linked immunosorbent assay (ELISA) was used to determine the plasma contents of transforming growth factor-β1 (TGF-β1),interleukin-6 (IL-6) and fibrinogen (Fib).Rabbits were examined macroscopically after dissection to assess intestinal adhesion and fistula formation.In addition,immunohistochemistry was used to quantify matrix metalloproteinase-1 (MMP-1) and matrix metalloproteinase-1 inhibitors (TIMP-1) in intestinal canal tissues.Results Plasma TGF-β1,IL-6 and Fib contents peaked 3 days after operation before gradually decreasing with time (6.21 ± 0.68,9.17 ± 2.32,9.78 ± 2.75),and reached normal levels at 14th day post-operation (4.07 ± 1.57,7.67 ±2.42,8.01 ± 1.92).However,similar protein amounts were found in laparoscopy and gauze piece scrub groups (P＞0.05),and significantly higher than in controls (P＜0.01).MMP-1 and TIMP-1 activities in the gauze piece scrub group were significantly higher than in laparoscopy and sham groups (37.42 ± 5.26,67.41 ±5.18 vs.32.46 ± 8.76,52.46 ± 6.81,P ＜ 0.05).Finally,intestinal adhesion and fistula formation were significantly increased in the gauze piece scrub group as compared with the laparoscopy group (P ＜ 0.05).Conclusion Gauze piece scrub induces inflammatory factor release,increases plasma fibrinogen levels,and enhances the activity of TIMP-1,thus promoting the formation of abdominal adhesions and T tube fistula.These findings provide a basis for a convenient,simple,feasible and efficacious method toward laparoscopic bile duct exploration of T tube fistula to shorten the time with T tube after operation.
