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胆道梗阻型损伤后机体组织病理学变化的实验观察

Experimental observation of pathological changes in the tissues after injurious biliary stricture

摘要:

目的 探讨胆道梗阻型损伤后胆管、肝脏及局部组织的病理变化过程,从中获得最佳手术修复时机的病理学基础。方法运用家犬制作梗阻型胆道损伤动物模型,动态观察胆管梗阻损伤后不同时间段内胆管形态学、局部组织病理学和肝脏病理学指标的变化情况。结果 胆管梗阻型损伤后,近端胆管随着压力的增加而持续扩张,第15天达(18.91±1.85)mm。损伤胆管局部组织出现急性炎症反应。损伤早期(10 d之内)管壁炎性细胞浸润增多,黏膜水肿加重,胆管壁呈炎性水肿样增厚。至梗阻后期(15d之后)炎性细胞浸润减少,水肿减轻,黏膜层变薄,成纤维母细胞增生及胶原组织增生广泛,管壁纤维增生性增厚。定量分析炎症水肿程度显示,以5d时最严重(HE染色WBC计数54.2士5.8个),到第15天炎症消退明显(HE染色WBC计数41.7士7.2比54.2±5.8个,P<0.05)。同时,在梗阻早期(BDL5、BDL10组)肝脏出现轻至中度的肝细胞浊肿变性伴脂肪变性,肝窦扩张充血。随着阻塞时间的延长,至梗阻后期(20 d、30 d)肝细胞出现广泛的空泡变性及肝窦闭塞。结论急性梗阻型胆管损伤后早期(5 d)出现胆管急速扩张,胆管及周围组织炎症水肿,肝实质损害。15d后局部炎症水肿消退,代之纤维及胶原增生。20 d后肝实质出现不可逆损害。综合局部环境及全身条件认为梗阻后10~20 d是手术进行一期修复的最好时间段。

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abstracts:

Objective To explore the histopathological changes of bile duct,liver and local tissue for injurious biliary stricture(IBS). Method To observe the morphological and pathological changes of bile duct, local tissue and liver in different periods with dogs as the established animal model for IBS. Result Bile duct obstruction due to injury can expand the proximal bile duct up to 18.91 ±1.85 mm as the pressure goes up. Damage to local tissue triggers acute inflammation. In early injury phase (within 10 d), inflammatory cell infiltration and proliferation appears on the wall of the duct with increased mucosal edema as well as thickening of the biliary ductile wall. In the late injury phase (15 d), the degree of infiltration of inflammatory cells, edema and mucosal thickness were reduced whereas fibroblast and collagen tissue were proliferated extensively. The wall of biliary duct also becomes fibrotic and thickens. Quantitative analysis of the inflammatory edema shows the most severe outcome on the 5th day (HE staining WBC count of 54.2±5.8 unit) and its severity progressively subsides on the 15th day. (HE staining WBC count of 41.7±7.2 vs 54.2±5.8 a, P<0.0,5). In the early obstruction (5 d and 10 d), the liver cells showed mild to moderate swelling and its degeneration is often associated with steatosis and sinusoidal expansion and congestion. As the obstruction time increases in the 20 d and 30 d group, liver cells starts to show extensive vacuolation and sinusoidal occlusion. Conclusions Early phase (5 days) of acute bile duct obstruction due to injury shows rapid expansion of the bile duct, edema in the bile duct itself as well as its surrounding tissue and liver damage. After 15 days, the local inflammatory edema is greatly reduced and is replaced by hyperplasia of fibers and collagen. Liver damage appears to be irreversible after 20 days. Considering local environmental and systemic conditions, the optimal time frame to repair obstruction of bile duct surgically is between 10-20 days.

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作者: 黄强 [1] 刘臣海 [1] 王成 [1] 胡元国 [1] 邱陆军 [1] 汤志刚 [1] 王士堂 [1] 林先盛 [1] 王世杰 [1] 谢放 [1]
期刊: 《中华肝胆外科杂志》2011年17卷9期 764-767页 ISTICPKUCSCD
分类号: R6
栏目名称: 实验研究
DOI: 10.3760/cma.j.issn.1007-8118.2011.09.022
发布时间: 2011-11-24
基金项目:
安徽省科技攻关计划面上项目
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