损伤性胆管狭窄手术时机与胆管胶原含量变化的实验研究

目的 损伤性胆管狭窄手术时机及手术方式是影响胆道修复重建手术效果的重要因素，目前临床上对于胆管狭窄手术时机对术后胆管再狭窄的影响仍存在争议。本研究通过动物模型的实验观察，了解手术时机与胆管胶原组织含量变化的关系，为临床上损伤性胆管狭窄手术时机的选择提供实验和理论依据。方法 荣昌大白猪20只随机分为对照组、胆管梗阻15d组、胆管梗阻1个月组、胆管梗阻3个月组。建立胆管损伤模型，胆管修复方式为狭窄段胆管切除后的胆管对端吻合术，观察胆管吻合口组织胶原含量的变化。结果 胆管梗阻后，胆管黏膜上皮坏死脱落、纤维结缔组织增生、管壁增厚。胆管修复术后胆管局部纤维组织增生程度、胶原含量与胆管梗阻时程呈正相关。胆管修复术距损伤时程越长，胆管胶原组织的含量越高，术后发生胆管吻合口再狭窄的机会越大，程度越重。结论 胆管损伤后胆管胶原组织含量的变化是影响胆管修复术后吻合口狭窄的重要因素，损伤时程越长，胶原含量越高，术后易发生胆管吻合口再狭窄。

Timing of operation for injurious biliary stricture and changes of collagen content in bile duct in pigs

Objective To establish an animal model of injurious biliary stricture (IBS) to investigate the relationship between timing of operation and collagen content in the bile duct to provide theoretical and experimental bases for selection of timing of operation for IBS in clinical practice. Methods Twenty-four Rongchang pigs were randomized into 4 groups. Group A was the normal control. The pigs in groups B, C and D were inflicted with obstructive jaundice for half a month, 1 month and 3 months, respectively. Partial ligation of the bile duct was conducted in the latter groups. The repairing method of the bile duct was end-to-end anastomosis after resection of the strictural segment. Changes in collagen content in the bile duct were observed. Results After bile duct obstruction, the bile duct wall presented with epithelial necrosis, fibrous tissue proliferation and thickening. The extent of fibrous tissue proliferation after prosthesis and collagen content at the anastomosis site were positively correlated to biliary obstruction duration. Longer interval between the prosthesis and bile duct injury and higher collagen content resulted in more chances and greater severity of recurrent biliary stricture. Conclusions The changes in collagen contents after bile duct injury are very important for pathogenesis of recurrent biliary stricture.