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題名 | Basic Study of the Hepatic Impairment Induced by the Total Parenteral Nutrition: The Stereological Analysis on the Structure of the Bile Canaliculi and Microvilli=以立體學分析全靜脈營養之肝臟變化 |
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作者 | 吳志雄; 賴鴻緒; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 34:2 民90.03-04 |
頁次 | 頁69-77 |
分類號 | 416.351 |
關鍵詞 | 全靜脈營養; 肝臟變化; 電子顯微鏡; 立體學; Stereology; Bile canaliculi; BC; Microvilli; MV; TPN-associated cholestasis; TPN-AC; |
語文 | 英文(English) |
中文摘要 | 全靜脈營養長久以來被廣泛使用在外科病患當他們長期不能由口進食或營養不良。肝臟變化是常見且嚴重的副作用。我們利用電子顯微鏡及立體學來研究不同靜脈營養輸液對肝臟微小器官所造成的變化。總共25隻大白鼠分成四組,第一組為控制組,第二、三、四組為研究組,分別灌注不同濃度+眶敹)及分枝氧肌酸。以電子顯微鏡及立體學分析肝臟微小器官:微膽管皮微絨毛之變化。結果以較高濃度分枝氯肌酸治療之老鼠其微膽管之面積密度比控制組減少百分之四十,由立體學顯示微膽管變圓且擴張,微絨毛面積密度增加百分之五十,立體學顯示其變扁平。由微膽管較擴張,微絨毛變扁平,有助於膽汁之排泄。由本研究顯示在全靜脈營養時較高分枝氯胺肌輸液可減少膽汁滯留,是較好的選擇。立體學可提供三度空間測量,對微小器官之研究有幫助。 |
英文摘要 | Total parenteral nutrition has been used in surgical field. One of the side effects is hepatic impairment. In the present study, we use electron mircoscopy and stereology to evaluate the effects of different composition of TPN on the morphological changes of hepatic organelles, try to improve the knowledge of total parenteral nutrition associated cholestasis (TPN-AC). Twenty-five adult rats were divided randomly into four groups. Gr.I (N=6) was sham operated and fed with regular rat chow. Gr.II (N=6) Gr.III (N=7) and Gr.IV (N=6) were treated with intravenous infusion of TPN with different compositions. Gr.II 20 % glucose and 3.5 % Molipron F , Gr.III 20% glucose and 3.5% Aminic, Gr.IV 30% glucose and 3.5% Aminic. The main difference between Molipron F and Aminic is the concentration of Branched Chain Amino Acid (BCAA); which is 22.6% (Molipron F) versus 35.9% (Aminic). After seven days of TPN treatment, the rats were sacrificed, liver tissue harvested for electron microscopic examination and stereology morphometric study. Microvilli become edematous, distorted and decreased in numbers in all TPN groups, most severe in Gr.II. Using the stereology technique, the relative length, surface, volume of bile canaliculi and microvilli were calculated. The surface density of bile canaliculi wall in Gr.III is 40% less than the control group, the volume density of bile canaliculi space remained unchanged in all four groups. The microvilli changed its surface density in Gr.III, which is significantly increased than the control group. From the above data, we concluded that bile canaliculi become expanded and rounded in Gr.III, the microvilli became elliptical and f1attened, which is more efficient in driving the bile. With wider bile canaliculi pathways and more efficient mocrovilli in Gr.III, total parenteral nutrition associated cholestasis is less prominent in Gr.III. Branched chain amino acid enriched solution is a better solution in TPN. Stereology offer morphometric data is helpful in TPN-AC study. |
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