不同浓度盐酸消融兔胆管的实验研究

目的：了解不同浓度盐酸消融胆管后兔的肝功及胆管组织改变,为临床应用消融栓塞胆管治疗肝内胆管结石提供实验依据。方法：观察20%、15%、10%和5%的盐酸消融右外叶胆管后兔的存活情况、肝脏功能和胆管组织病理改变。结果：胆管消融术后所有动物均未死亡,存活率100%。20%盐酸及15%盐酸胆管消融造成兔右外叶肝脏几近坏死。10%盐酸胆管消融导致兔右外叶近肝门部肝实质完全坏死,肝叶中部及边缘组织以汇管区为中心的大片坏死。5%盐酸胆管消融后兔右外叶近肝门部及中部肝实质以汇管区为中心的坏死,肝叶边缘仅胆管坏死。与20%、15%和10%盐酸组兔相比,5%盐酸组的肝功能损害最轻。结论：盐酸作为胆管消融剂,能够导致胆管组织凝固性坏死,破坏胆管上皮,终止胆管上皮及胆管周围腺体的分泌;5%为盐酸消融胆管的较理想浓度。

Preliminary screening of hydrochloric acid for selective bile duct ablation and embolization

Objective： To study pathological changes of intrahepatic bile ducts after ablation with hydrochloric acid in rabbits. Methods： Twenty-four rabbits were divided into group A（20% hydrochloric acid, n=6）, group B（15% hydrochloric acid, n=6）, and group C（10% hydrochloric acid, n=6）, group D（5% hydrochloric acid, n=6）. The hepatic histopathology and the survival rate of the rabbits were observed. Results： In group A and group B, right external lobe liver was barely completely necrosis after ablation with hydrochloric acid. There was only a few of normal liver tissues remain at the edge of liver lobe. In group C, most of the liver tissues near porta hepatis were necrosis,and portal area tissues were necrosis in the middle and at the edge of the lobe. In group D, liver tis-sue near hepatic porta and in the middle of lobe were necrosis. The biliary tracts were necrosis at the edge of lobe and there were not obviously hepatic tissues necrosis. Conclusions： Hydrochloric acid as a biliary ablation agent, can lead to coagulation necrosis of biliary tract, epithelium of bile duct destruction, termination of secretion by bile duct epithelium and peribiliary glands. 5% is the proper concentration of hydrochloric acid for selective bile duct ablation.