CAJ | 학술논문

目的制作一种新型丝裂霉素药物洗脱支架,评价其在兔胆管良性狭窄模型中应用的有效性及安全性.方法选用健康新西兰白兔32只,电灼损伤胆总管造胆管狭窄模型.手术1个月后随机分3组,药物支架组(12只),普通支架组(12只)及对照组(8只),放置后观察动物的一般状况,生存率,肝功能变化.30 d后取狭窄处标本,HE染色光镜下观察胆管组织,免疫组织化学SP法测量TGF-β1及α-SMA的表达.结果植入药物及普通支架均可有效治疗胆总管狭窄,肝功能检测两支架组有明显好转,药物支架组血清总胆红素平均从最高5.56 μmoV1将至0.82 μmol/l,普通支架组从最高6.72 μmol/l将至0.87 μmol/l,最但两组之间差异无统计学意义(P＞0.05),对照组肝功能未见好转.病理学观察药物支架组胆管无纤维化增生,狭窄段直径较普通支架组略大.对照组管腔狭窄,炎性细胞浸润,黏膜下胶原纤维增生明显.免疫组化可见α-SMA、TGF-β1强表达于对照组狭窄胆管,在普通支架组表达也较强,弱表达于药物支架组,两支架组之间具有统计学意义(P＜0.05).结论丝裂霉素药物支架在良性胆管狭窄中的应用是安全可行的,除了具有机械性扩张胆管的作用外,由于支架具有药物缓释作用,在局部可持续释放药物,对胆管瘢痕的形成起到一定的抑制作用.
목적 제작일충신형사렬매소약물세탈지가,평개기재토담관량성협착모형중응용적유효성급안전성.방법 선용건강신서란백토32지,전작손상담총관조담관협착모형.수술1개월후수궤분3조,약물지가조(12지),보통지가조(12지)급대조조(8지),방치후관찰동물적일반상황,생존솔,간공능변화.30 d후취협착처표본,HE염색광경하관찰담관조직,면역조직화학SP법측량TGF-β1급α-SMA적표체.결과 식입약물급보통지가균가유효치료담총관협착,간공능검측량지가조유명현호전,약물지가조혈청총담홍소평균종최고5.56 μmoV1장지0.82 μmol/l,보통지가조종최고6.72 μmol/l장지0.87 μmol/l,최단량조지간차이무통계학의의(P＞0.05),대조조간공능미견호전.병이학관찰약물지가조담관무섬유화증생,협착단직경교보통지가조략대.대조조관강협착,염성세포침윤,점막하효원섬유증생명현.면역조화가견α-SMA、TGF-β1강표체우대조조협착담관,재보통지가조표체야교강,약표체우약물지가조,량지가조지간구유통계학의의(P＜0.05).결론 사렬매소약물지가재량성담관협착중적응용시안전가행적,제료구유궤계성확장담관적작용외,유우지가구유약물완석작용,재국부가지속석방약물,대담관반흔적형성기도일정적억제작용.
Objective To produce a kind of biliary stent with Mitomycin C-eliting and evaluate the availability and safety in biliary benign stricture model of rabbit.Methods 36 New Zealand rabbits were fulgurize choledochus to establish model of biliary benign stricture.Rabbits were randomly divided into Mitomycin C-eluting stent group 1 (n =12),polyurethane stent group 2 (n =12) and control group 3 (n =12) one month later.General conditions,survival of the animals and changes in liver function were observed after surgery.The histological changes of bile duct were observed after 30 days.The immunohistochemistry SP method was used to measure transforming growth factor-β1 (TGF-β1) and α-Smooth muscle actin (α-SMA) expression.Results Stricture was improved in the two stent groups.In Mitomycin C-Eluting stent group total bilirubin dropped from 5.56 μmol/l to 0.82 μmol/l,and in polyurethane stent group total bilirubin dropped from 6.72 μmol/1 to 0.87 μmol/l.The total bilirubin decreased in both two stent groups but no statistically significant between the two stent groups,and there were no improvement in control group.Diameter of the stricture bile duct in group 1 was expanded bigger than in group 2 according to histology observation.Inflammatory cell infiltration and collagen fibroplasia in the submucosal were obviously observed in control group.The immunohistochemistry results showed that the TGF-β1 and α-SMA strongly expressed in the stenosis bile duct of group 3.The expressions in group 2 were lower than group 3,but higher than in group 1.And there was significant difference between the two stent groups (P ＜ 0.05).Conclusion The new Mitomycin C-Eluting stent is safe and provides enhanced local drug delivery.It also can inhibit the form of Biliary scar to a certain degree.