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目的通过动物实验研究,观察选择性胆管栓塞所致肝脏功能和组织学变化,探讨其治疗胆管细胞癌的可能性。方法应用无水酒精或α-氰基丙烯酸正辛酯(DTH胶)对新西兰兔行选择性胆管栓塞,与正常新西兰兔比较,进行大体、组织学观察,并检测肝脏功能变化。结果栓塞术后30 d被栓塞肝叶萎缩,体积减小,质地变硬,光镜下肝小叶结构消失,肝细胞消亡,汇管区结缔组织增生明显。未栓塞肝叶代偿性肥大,肝细胞体积及密度增大,门静脉扩张充血。肝功能呈一过性改变,表现为术后3 d转氨酶(GPT、GOT)明显升高,术后14 d降至正常基线水平。DTH胶对肝功能(GPT、GOT)的损害要轻于无水酒精组(F=9.593,P=0.015;F=16.401,P=0.004)。结论选择性胆管栓塞可使被栓塞肝叶明显萎缩、纤维化,而未栓塞肝叶代偿性增生肥大,DTH胶栓塞效果较无水酒精相对安全有效,可能作为胆管细胞癌治疗的一种辅助措施。
Objective To observe the liver function and histological changes induced by selective bile duct embolization through animal experimental study and explore its possibility of treating cholangiocarcinoma. Methods The selective bile duct embolization of New Zealand rabbits with anhydrous alcohol or n-octyl α-cyanoacrylate (DTH gum) was performed. The gross and histological changes were observed and compared with those of normal New Zealand rabbits. Results Embolization of the hepatic lobule atrophy occurred 30 days after embolization, the volume was reduced, the texture was hardened, the structure of hepatic lobules disappeared under light microscope, and the hepatocytes died. The connective tissue hyperplasia in portal area was obvious. Compensatory hypertrophy of non-occluded livers, hepatocyte volume and density increase, portal vein dilation and congestion. Liver function showed a transient change, manifested as 3 days after transaminase (GPT, GOT) was significantly increased 14 days after the baseline level dropped to normal. DTH gum damage to liver function (GPT, GOT) was lighter than anhydrous alcohol group (F = 9.593, P = 0.015; F = 16.401, P = 0.004). Conclusions Selective cholangial embolization can cause marked atrophy and fibrosis of the embolized lobe, while compensatory enlargement and hypertrophy of non-embolized lobe and relatively safe and effective DTH adhesive embolization may serve as an adjunct to the treatment of cholangiocarcinoma Measures.