目的:膽總管結(jié)石為膽道外科常見疾病,輕者可無明顯癥狀,重者可進一步發(fā)展,堵塞膽管,造成梗阻性黃疸。隨著腹腔鏡技術(shù)的開展,腹腔鏡膽總管探查取石術(shù)（LCBDE）已經(jīng)成為膽總管結(jié)石的主要治療方式。術(shù)后膽道引流可解除膽道梗阻,降低膽道壓力,減輕炎性膽汁反流,促進局部炎癥消退等,但其仍存在不可忽視的并發(fā)癥。梗阻性黃疸和膽汁引流后均可造成腸道內(nèi)膽汁缺乏,可導(dǎo)致腸黏膜屏障功能的破壞,細菌和內(nèi)毒素移位,引起菌血癥和內(nèi)毒素血癥,誘導(dǎo)促炎細胞因子的產(chǎn)生（TNF-α,IL-6）,誘發(fā)全身性炎癥反應(yīng)綜合征,可能導(dǎo)致多器官功能障礙綜合征。腸上皮屏障主要包括機械屏障、化學(xué)屏障、生物屏障和免疫屏障。其中機械屏障是腸上皮屏障最重要的一道防線。機械屏障主要由上皮細胞和細胞間緊密連接（TJs）構(gòu)成。緊密連接是一組跨膜蛋白,水閘蛋白（Claudins）、閉鎖蛋白（Occludin）和膜內(nèi)閉鎖小帶蛋白（ZOs）以及鄰近的粘附連接（E-cadherin）組成,它們通過與鄰近細胞相互作用形成選擇性屏障。研究表明維生素D可通過激活維生素D受體（VDR）維護腸黏膜屏障功能。維生素D受體同時也是膽汁酸的感應(yīng)器,膽汁中石膽酸（LCA）是... 

【文章來源】：中國醫(yī)科大學(xué)遼寧省

【文章頁數(shù)】：114 頁

【學(xué)位級別】：博士

【部分圖文】：

SD大鼠膽汁外引流和梗阻性黃疸模型

各組大鼠體重變化情況

各組大鼠腸黏膜病理變化

【參考文獻】：
期刊論文
[1]Pathophysiological consequences of obstructive jaundice and perioperative management[J]. Efstathios T Pavlidis,Theodoros E Pavlidis.  Hepatobiliary & Pancreatic Diseases International. 2018(01)
[2]Tight junctions in inflammatory bowel diseases and inflammatory bowel disease associated colorectal cancer[J]. Jonathan Landy,Emma Ronde,Nick English,Sue K Clark,Ailsa L Hart,Stella C Knight,Paul J Ciclitira,Hafid Omar Al-Hassi.  World Journal of Gastroenterology. 2016(11)
[3]role of the normal gut microbiota[J]. Sai Manasa Jandhyala,Rupjyoti Talukdar,Chivkula Subramanyam,Harish Vuyyuru,Mitnala Sasikala,D Nageshwar Reddy.  World Journal of Gastroenterology. 2015(29)
[4]Glucagon-like peptide-2 protects impaired intestinal mucosal barriers in obstructive jaundice rats[J]. Jun Chen,Jia-Tian Dong,Xiao-Jing Li,Ye Gu,Zhi-Jian Cheng,Yuan-Kun Cai.  World Journal of Gastroenterology. 2015(02)
[5]膽汁酸代謝及相關(guān)核受體研究進展[J]. 肖夢宇.  中國城鄉(xiāng)企業(yè)衛(wèi)生. 2014(03)
[6]Effects of Lactobacillus plantarum on gut barrier function in experimental obstructive jaundice[J]. Yu-Kun Zhou,Department of Hepatobiliary Surgery,No.455 Hospital of People’s Liberation Army,Shanghai 200052,China Huan-Long Qin,Ming Zhang,Tong-Yi Shen,Hong-Qi Chen,Yan-Lei Ma,Zhao-Xin Chu,Peng Zhang,Zhi-Hua Liu,Department of Surgery,The Sixth People’s Hospital,Shanghai Jiaotong University,Shanghai 200233,China.  World Journal of Gastroenterology. 2012(30)
[7]Effects of recombinant human growth hormone on intestinal translocation of bacteria and endotoxin in rats with obstructive jaundice[J]. Department of General Surgery ( Yang ZW, Li JG, Mao XG, Sun B and Cong YP), Department of Clinical Examination (Tong ZS and Sun HY) and Department of Pathology (Li XR) , Heilongjiang Provincial Hospital, Harbin 150036, China.  Hepatobiliary & Pancreatic Diseases International. 2005(03)



本文編號：3528789