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頁籤選單縮合
題名 | The Ultrastructural Changes of the Common Bile Duct Following Reflux of Pancreatic Juice in a Canine Model=胰臟液逆流引起之總膽管電子顯微鏡病理變化 |
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作者姓名(中文) | 林哲男; 駱至誠; 何逸僊; |
作者姓名(外文) | Lin, Jer-nan; Luo, Chih-chang; Ho, Yat-sen; |
書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 32:5 民88.09-10 |
頁次 | 頁202-207 |
分類號 | 415.113 |
語文 | eng |
關鍵詞 | 胰臟液; 逆流; 膽管; Choledochal cyst; Abnormal pancreaticobiliary duct union; Pancreatic juice reflux; Electromicroscopic examination; |
中文摘要 | 膜液經不正常膽胰管合流逆流至膽道,長久以來被認為是膽道轟腫之重要病因。但實際上膽道經長期膜液沖灌所引起膽管的型態學變化仍然不明。我們在25隻成狗應用膽管與胰管之直接吻合術產生胰液持續迴流至膽道的動物模型。在術後1,2, 4, 8, 16,與32週分別取出肝臟及膽道作型態學及電子顯微鏡檢之分析研究。其中22隻呈現明顯總膽管擴張(直徑7-15毫米,正常值2.2±0.8毫米)。總膽管之擴大在術後2週已達極限,此最大值在32週犧牲之狗仍然相同。在電子顯微鏡檢下,總膽管擴張部呈現明顯黏膜層剝落,細胞間隔「分離」基膜退化與破裂,次黏膜層血管栓塞與缺血壞死,深肌肉層膽汁色素沉澱與破損。這些變化表示總膽管之破壞為一種化學變化。我們認為膽汁與胰液之混合液本身即可造成總膽管管壁之破壞,且可引發侷限性膽道擴張。 |
英文摘要 | Pancreatic juice refluxing into the common bile duct (CBD) through an anomalous pancreaticobiliary ductal union has been regarded as one of the etiology in forming a choledochal cyst. However, the actual morphological changes of the CBD and hence the pathogenesis have not been demonstrated. A canine model in which continuous reflux of pancreatic juice into the bile duct was created by pancreaticocholedochostomy (PCS) were performed in 24 mongrel adult dogs. Twenty one dogs after PCS showed dilatation of CBD (diameter 7 to 15 mm, normal 2.2 ± 0.8 mm) when they Were sacificed at 1, 2, 4, 8, 16 and 32 weeks respectively. The size of CBD reached maximally at 2 weeks after PCS, and remained the same at 32 weeks. The ultrastructure of the dilated CBD when examined under electron microscope showed mucosal sloughing, "splitting" of the intercellular junctional structures, basement membrane degeneration and rupture, submucosal vessel occlusion with ischemic necrosis, bile pigment deposition and fragmentation of the deep muscle layer. All these changes in the CBD suggested chemical destructive processes. We concluded that the bile-pancreatic juice mixture is harmful to the common bile duct and may cause limit degree of dilatation. |
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