【作者】 胡曙东；

【导师】 吕维富；

【作者基本信息】 安徽医科大学 ， 影像医学与核医学， 2004， 硕士

【摘要】 目的 通过动物实验研究初步探讨经皮肝穿刺胆管——胃十二指肠内引流治疗梗阻性黄疸，特别是常规介入放射学技术不能解除梗阻的顽固性胆道梗阻，安全性和有效性以及相关的一些技术问题。材料与方法 健康杂种家猪20只，雄性9只，雌性11只，行胆总管结扎，建立梗阻性黄疸动物模型。术后14天，随机分成两组：(1)经皮肝穿刺胆管——胃十二指肠内引流组(A组，n=10)：在DSA引导下行经皮肝穿刺胆管——胃十二指内引流，置入内引流管。(2)模型对照组(B组，n=10)：单纯行外科性胆总管结扎后，未行干预治疗措施。在不同时间段内抽血检查，观察总胆红素(TBIL)、直接胆红素(DBIL)、谷丙转氨酶(ALT)，白蛋白(ALB)，比较各组间及干预前后差异，观察不同时间段肝脏病理学和影像学改变。结果A组介入技术成功率100％，其中1只死于经皮肝穿刺胆管——胃十二指肠内引流介入术后第11天，死亡原因：消化道出血。并发症发生率50％，主要为胆管出血、发热。B组分别死于胆总管结扎术后23天至32天，平均生存时间为28.3天。实验动物随梗阻时间的延长，TBIL、DBIL、ALT呈持续升高，经引流后TBIL、DBIL、ALT下降明显，ALB随胆管梗阻时间延长，有所下降。影像学表明：胆总管结扎后14天肝内胆管扩张明显，介入治疗后肝内胆管未见明显梗阻、扩张征象。病理示经介入治疗肝组织结构明显好转，肝内胆管未见明显梗阻、扩张征象。结论 经皮肿穿刺胆管——胃十二指肠内引流术是治疗胆管梗阻，特别是常规介入放射学技术不能成功的顽固性胆道梗阻，是安全、有效的、微创的治疗方法，是介入放射学又一新的治疗手段，可以考虑选择性地应用于临床，进一步研究其有效性和安全性。更多还原

【Abstract】 Objective To evaluate the safety and efficacy of percutaneous transhepatic gastrobiliary duodenal internal drainage therapy for obstructive biliary, especially refractory obstructive biliary, with an animal experimental study and several technicals points involved in this method discussed. Materials and Methods 20 cases of local ,healthy, crossbred pigs , including 9 males and 11 females ,their common bile ducts were ligated. They were randomly divided into two groups :One group (Group A ,n=10 ) called percutaneous transhepatic gastrobiliary duodenal internal drainage interventional treatment group, with percutaneous transhepatic gastrobiliary duodenal internal drainage after common bile ligation’s 14 days, the other ( Group B , n=10 ) called control group, with only common bile duct ligation. The liver function levels including TBIL,DBIL,ALT,ALB are determined in plasma in the special time. The liver tissues were HE dyed and inspected with optical microscope. CT scan of liver was performed. Results Technical success rate was 100% in Group A. One case was died of gastrointestinal bleeding after percutaneous transhepatic gastrobiliary duodenal internal drainage therapy the list day and the complications occurred in 50%,mainly included biliary hemobilia, fever in group A. All animals died during the 23 rd to 32 nd day after common bile duct ligation in group B. The mean survival time was 28.3 days . The contents of TBIL ,DBIL, ALT continuously increased and were obviously declined after percutaneous transhepatic gastrobiliary duodenal internal drainage therapy. The liver tissue was rebuilt and inspected without biliary obstruction signs. Conclusion The percutaneoustranshepatic gastrobiliary duodenal internal drainage was quite safe and effective palliative therapy for obstructive biliary, especially refractory obstructive biliary.更多还原