可调控胆管良性狭窄动物模型的实验研究

发布时间：2018-06-28 16:07

本文选题：良性胆管狭窄 + 巴马小型猪　；参考：《医学研究生学报》2017年07期

【摘要】：目的目前对胆管良性狭窄动物模型的研究尚少。探讨建立可调控胆管良性狭窄动物模型的方法。方法小型猪按随机数字表法分为假手术组、传统手术组、小口径组、大口径组,每组6只。其中小口径组以外径3.0 mm导管置入胆总管后行部分缝扎;大口径组以外径6.0 mm导管置入胆总管后行部分缝扎。传统手术组用5-0可吸收线对胆管下段部分缝扎,大致目视下控制狭窄程度。假手术组仅暴露胆管,未行缝扎处理。术后观察4组动物的一般状况;术后1,3,7,14,21,28 d检测肝功能水平;术后30 d行经胆囊胆道造影;造影术后所有猪均处死,解剖观察肝及胆管组织学变化情况。结果假手术组肝功能水平于整个观察期内未见明显变化。术后第28天,与传统手术组比较,小口径组肝酶检测指标ALT、AST、γ-GT、ALP、胆红素水平升高(P0.05);大口径组肝酶检测指标ALT、AST、γ-GT、胆红素水平升高(P0.05),而大口径组较小口径组ALP水平降低(P0.05)。胆管造影示:小口径组6只猪胆管内明显可见不同程度狭窄,平均直径2.7 mm(2~4 mm);大口径组有5只猪可见明显管腔狭窄,狭窄段胆管直径为平均5.5 mm(5~7 mm),传统手术组有3只猪未见明显管腔狭窄,假手术组6只猪均无胆管狭窄形成。根据设计的狭窄形成标准,小口径组、大口径组狭窄成功率均高于传统手术组(P0.05)。术后30 d小口径组6只猪均出现腹腔粘连,肝肿大,肝内胆管明显扩张,胆囊扩张可达原来5~6倍。大口径组5只猪肝肿大,肝内胆管轻度扩张,胆囊扩张明显,胆总管水肿明显,缝扎部位组织增厚,胆管可见狭窄。HE染色见小口径组肝细胞点状变性坏死,肝内小胆管呈扩张淤胆状态,肝细胞肿胀,出现纤维隔;大口径组可见肝内小胆管呈轻度扩张状态,肝细胞排列基本正常。VG染色见小口径组胆管黏膜细胞外胶原纤维沉积过度,排列杂乱而较密,形状不规则。大口径组胆管黏膜下胶原纤维增多,排列致密呈条带状。结论此模型具有手术成功率高,并发症少等优点,是较为理想的胆管良性狭窄大动物模型。
[Abstract]:Objective to study the animal model of benign stricture of bile duct. To establish the animal model of benign stenosis of bile duct. Methods Pigs were randomly divided into sham-operation group, traditional operation group, small-caliber group and large-caliber group with 6 pigs in each group. In the small diameter group, the common bile duct was partly sutured with an external diameter of 3.0 mm catheter, and the large caliber group was partly sutured with the external diameter of 6.0 mm catheter placed in the common bile duct. In the traditional operation group, 5-0 absorbable line was used to suture the lower part of bile duct to control the degree of stenosis. In the sham operation group, only the bile duct was exposed without suture ligation. After operation, the general condition of the four groups was observed, the liver function was measured on the 28th day after operation, the choledochography was performed 30 days after operation, all the pigs were killed after contrast, and the histological changes of liver and bile duct were anatomically observed. Results there was no significant change in liver function in sham operation group during the whole observation period. On the 28th day after operation, the levels of alt AST, 纬 -GTT ALPand bilirubin in small caliber group were higher than those in traditional operation group (P0.05), and ALT, 纬 -GT, bilirubin level in large caliber group were higher (P0.05), while ALP level in large caliber group was lower than that in small diameter group (P0.05). Cholangiography showed that there was significant stenosis in the bile duct of 6 pigs in the small diameter group, and the mean diameter was 2. 7 mm (2? 4 mm);) in the large diameter group, and 5 pigs in the large diameter group were found to have obvious stenosis in the bile duct. The mean diameter of narrow segment bile duct was 5.5mm (5 ~ 7 mm),) in 3 pigs without obvious lumen stenosis, and no bile duct stenosis was found in the sham operation group (n = 6). According to the standard of stenosis formation, the success rate of small diameter group and large diameter group was higher than that of traditional operation group (P0.05). 30 days after operation, 6 pigs in small caliber group had abdominal adhesion, hepatomegaly, intrahepatic bile duct dilatation and gallbladder dilatation up to 5 times. In the large caliber group, 5 pigs had hepatomegaly, mild intrahepatic bile duct dilatation, gallbladder dilatation, common bile duct edema, thickening of suture tissue, and hepatic cell degeneration and necrosis in small caliber group. The small bile duct in the liver was dilated and cholestatic, the hepatocytes were swollen and fibrous septum appeared. In the large caliber group, the small bile duct was slightly dilated, and the arrangement of hepatocytes was basically normal. VG staining showed that the collagenous fibers in the bile duct mucous membrane of the small diameter group were excessive. Disordered and dense, irregular in shape. In large diameter group, submucosal collagenous fibers were increased and arranged in a strip. Conclusion this model has the advantages of high success rate and less complications. It is an ideal large animal model of benign stricture of bile duct.
【作者单位】：南京医科大学鼓楼临床医学院肝胆外科;
【分类号】：R-332;R657.4

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