损伤性胆管狭窄手术时机对肝功能变化影响实验研究.docVIP

损伤性胆管狭窄手术时机对肝功能变化影响实验研究 　　摘 要：目的 研究?p伤性胆管狭窄手术时机对肝功能变化的影响。方法 选取32只家兔，随机分为4组，每组8只。A组直接行胆管切断对端吻合术，B组胆管梗阻20 d、C组胆管梗阻30 d，D组胆管梗阻80 d，一期胆总管均置入橡皮塞，造成不完全性胆管梗阻，3个月后进行胆道再通及胆管对端吻合术，测定各组肝功能指标，对比肝功能变化情况。结果 兔梗阻二期术前B、C、D组血清总胆红素（TBIL）、直接胆红素（DBIL）、谷丙转氨酶（ALT）、碱性磷酸酶（ALP）水平明显高于A组，且D组明显高于B、C组，差异有统计学意义（P0.05），C、D组明显下降，差异有统计学意义（P0.05）。结论 损伤性胆管狭窄手术，应遵循越早越好的原则，以促进肝功能的恢复，尽早进行胆管修复重建术，对肝功能损害小，肝功能恢复较快，具有重要的临床意义。 　　关键词：损伤性胆管狭窄；手术时机；肝功能 　　中图分类号：R657.4 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.03.024 　　文章编号：1006-1959（2018）03-0078-03 　　Abstract：Objective To study the influence of the timing of surgery for traumatic biliary stricture on the changes of liver function. Methods 32 rabbits were selected and randomly divided into 4 groups with 8 in each.Group A underwent direct choledochotomy and end-to-end anastomosis.Group B had biliary obstruction for 20 d，group C had biliary obstruction for 30 d，group D had 80 d of obstruction，In one stage，rubber plug was inserted into the common bile duct，resulting in incomplete bile duct obstruction.After 3 months of operation，bile duct recanalization and cholangiostomy were performed to determine the liver function of each group.Results The levels of serum total bilirubin （TBIL），direct bilirubin（DBIL），alanine aminotransferase（ALT）and alkaline phosphatase（ALP）in groups B， C and D before operation were significantly higher than those in group A，group D was significantly higher than group B and C（P0.05），C and D group decreased significantly，the difference was statistically significant（P0.05）.Conclusion The surgical injury of bile duct stricture，should follow the principle as early as possible，in order to promote liver function can recover as soon as possible，bile duct reconstruction，less damage to liver function and liver function recovery，has important clinical significance. 　　Key words：Injury biliary stricture；Operation timing；Liver function 　　胆管损伤（Bile duct injury）是胆道手术的严重并发症之一，通常病情复杂，治疗困难，若治疗不当，会导致患者接受多次手术治疗，不仅增加了治疗难度，且疗效逐渐降低，严重时会发展成为肝硬化、肝衰竭，出现较高的病死率[1]。