巴马小型猪胆道盐酸消融实验 - 第三军医大学学报.DOC

巴马猪胆道盐酸消融实验 杨爱军1ab，董家鸿2（1.第三军医大学：a.基础部外科应用解剖与手术学教研室；b.西南医院肝胆外科，重庆 400038；2.中国人民解放军总医院肝胆外科，北京 100853） 提要：目的 盐酸氰基丙烯酸酯后病理肝功改变，为临床应用胆道消融栓塞治疗肝内胆管结石提供实验依据。 方法 猪外叶胆道消融并栓塞动物的肝脏功能状态、组织病理改变和术后存活情况。 结果 靶肝叶纤维化。 结论 5%盐酸是巴马猪有效的胆道消融剂。 关键词： 肝内胆管结石；消融；盐酸；猪 中图法分类号 R575.62 文献标识码：A EXPEREMENT OF SELECTIVE BILE DUCT ABLATION WITH HYDORCHLORIC ACID IN BAMA SWINES YANG Ai-jun, DONG Jia-hong (Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China) Abstract: Objective To study pathological changes after ablation with hydrochloric acid in intrahepatic bile ducts in Bama swines. Methods 5% hydrochloric acid was used as ablation reagent. The pathologic changes and liver function were evaluated after selective bile duct ablation. The hepatic histopathology and the survival rate of the Bama swines were observed. Results The index of liver function enzymes increased quickly during the first several days and decreased to normal levels on day 7 postoperation. Pathological analysis suggested hepatic cell death , bile duct fibrosis, inflammation cells infiltration and fibroblast proliferation. Liver atrophy and fibrosis were obvious on week 4. Masson stain suggested collagen increased remarkably 4 weeks after ablation (P0.05). Conclusions 5% is the proper concentration of hydrochloric acid for selective bile duct ablation in Bama swines. Keywords: hepatolithus; ablation; hydrochloric acid; Bama swine [作者简介] 杨爱军（1977-），男，云南省昆明市人，讲师，硕士，主要从事肝内胆管结石方面的研究。电话：（023E-mail：yangaijun1977@ 肝内胆管结石是按肝内胆道系统分布的节段性、区域性疾病[1]。基于肝内区域胆管完全梗阻后可造成分布区域肝脏组织的萎缩纤维化而“自裁”的特点，考虑通过区域肝内胆道消融栓塞祛除结石复发的条件和环境，人为造成栓塞区域肝脏组织的萎缩纤维化，以期达到治疗无法手术治疗的肝内胆管结石病的目的，为无法实施外科手术治疗的肝胆管结石的治疗寻找新的治疗途径。小型动物大型哺乳动物。本实验拟应用筛选出的消融栓塞剂对大型动物行胆道消融栓塞，以期了解区域性胆道消融栓塞后大型动物局部肝脏组织病理改变及其对肝脏功能的影响，为临床应用提供实验研究依据。 1 材料与方法 1.1 实验动物及方法：健康雄性巴马小型猪5头，体重3539 kg。术前12 h禁食水。予以10 mg/kg盐酸氯胺酮0.5 mg硫酸阿托品肌注行麻醉诱导。气管插管成功后连接呼吸机。呼吸模式CAMV，潮气量为10 m/kg，呼吸频率为20次/min，FiO2为0.4。缓慢静滴氯胺酮、氯化琥珀酰胆碱，维持麻醉