本文選題：良性膽管狹窄 + 巴馬小型豬��； 參考：《醫(yī)學研究生學報》2017年07期

【摘要】：目的目前對膽管良性狹窄動物模型的研究尚少。探討建立可調(diào)控膽管良性狹窄動物模型的方法。方法小型豬按隨機數(shù)字表法分為假手術組、傳統(tǒng)手術組、小口徑組、大口徑組,每組6只。其中小口徑組以外徑3.0 mm導管置入膽總管后行部分縫扎;大口徑組以外徑6.0 mm導管置入膽總管后行部分縫扎。傳統(tǒng)手術組用5-0可吸收線對膽管下段部分縫扎,大致目視下控制狹窄程度。假手術組僅暴露膽管,未行縫扎處理。術后觀察4組動物的一般狀況;術后1,3,7,14,21,28 d檢測肝功能水平;術后30 d行經(jīng)膽囊膽道造影;造影術后所有豬均處死,解剖觀察肝及膽管組織學變化情況。結果假手術組肝功能水平于整個觀察期內(nèi)未見明顯變化。術后第28天,與傳統(tǒng)手術組比較,小口徑組肝酶檢測指標ALT、AST、γ-GT、ALP、膽紅素水平升高(P0.05);大口徑組肝酶檢測指標ALT、AST、γ-GT、膽紅素水平升高(P0.05),而大口徑組較小口徑組ALP水平降低(P0.05)。膽管造影示:小口徑組6只豬膽管內(nèi)明顯可見不同程度狹窄,平均直徑2.7 mm(2~4 mm);大口徑組有5只豬可見明顯管腔狹窄,狹窄段膽管直徑為平均5.5 mm(5~7 mm),傳統(tǒng)手術組有3只豬未見明顯管腔狹窄,假手術組6只豬均無膽管狹窄形成。根據(jù)設計的狹窄形成標準,小口徑組、大口徑組狹窄成功率均高于傳統(tǒng)手術組(P0.05)。術后30 d小口徑組6只豬均出現(xiàn)腹腔粘連,肝腫大,肝內(nèi)膽管明顯擴張,膽囊擴張可達原來5~6倍。大口徑組5只豬肝腫大,肝內(nèi)膽管輕度擴張,膽囊擴張明顯,膽總管水腫明顯,縫扎部位組織增厚,膽管可見狹窄。HE染色見小口徑組肝細胞點狀變性壞死,肝內(nèi)小膽管呈擴張淤膽狀態(tài),肝細胞腫脹,出現(xiàn)纖維隔;大口徑組可見肝內(nèi)小膽管呈輕度擴張狀態(tài),肝細胞排列基本正常。VG染色見小口徑組膽管黏膜細胞外膠原纖維沉積過度,排列雜亂而較密,形狀不規(guī)則。大口徑組膽管黏膜下膠原纖維增多,排列致密呈條帶狀。結論此模型具有手術成功率高,并發(fā)癥少等優(yōu)點,是較為理想的膽管良性狹窄大動物模型。
[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, 緯 -GTT ALPand bilirubin in small caliber group were higher than those in traditional operation group (P0.05), and ALT, 緯 -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.
【作者單位】： 南京醫(yī)科大學鼓樓臨床醫(yī)學院肝膽外科;
【分類號】：R-332;R657.4

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本文編號：2078570