兔胆管电热损伤早期修复过程中组织病理学变化

摘要

目的 探讨胆管电热损伤早期修复过程中组织病理学变化特征,为术中即时修复胆管电热损伤提供理论和动物试验中的依据.方法 通过建立兔胆管电热损伤早期修复模型,分别于术后即刻及3d、5d、7d、14d取材,用10%甲醛固定,经石蜡包埋、切片和HE染色,光镜下观察及分析胆管电热损伤早期修复过程中组织病理学变化.结果 对照组正常胆管壁结构,即刻手术组可见电热损伤处胆管壁组织大片气化坏死,少量炎细胞浸润;3d手术组胆管病变部位可见全层炎性坏死,纤维组织增生,炎性细胞浸润明显;5d手术组胆管壁电热损伤改变特征基本同第3天,但全层纤维组织增生明显,管腔稍增厚;7d手术组电热损伤胆管上皮细胞发生凝固性坏死变化,周围有结缔组织增生,炎性细胞浸润较明显,管壁增厚明显;14d手术组电热损伤胆管上皮层结构无法辨认,周围全层结缔纤维组织增生明显,可见散在的炎性细胞浸润,管壁明显增厚.损伤范围平均(3.86±0.32)mm.结论 电热损伤胆管壁全层,损伤范围远大于肉眼所见,随着损伤后时间的迁徙,损伤处的胆管壁纤维化程度逐渐高、胆管壁厚度逐渐增厚、胆管腔逐渐狭窄.%To probe the characteristics of the histopathological changes in the early repair processof bile duct injured by electric heat for providing the theoretic basis and animal experiments for the immediate repair of the intraoperative bile duct injured by electric heat. Methods Materials were obtained through the estab lishment of the model s of rabbit bile duct injured by electric heat of early repair process immediately and postoperatively 3, 5, 7 and 14 days, respectively, with 10% formalin-fixed,paraffin-embedded, slicing and HE staining. The early repair process of pathological changes of the bile duct injured with electric heat were observed under the light microscope and analyzed. Results In the control group of normal bile duct structure, large areas of gasification necrosis and infiltration of small amount inflammatory cells could be seen at the injured wall of the bile duct caused by electric heat in the immediate operative group; the inflammatory necrosis of the whole layers, hyperplasia of the fibrous tissue, and predominant infiltration of the inflammatory eel ls were found at the damaged part of the bile duct in the postoperative 3 days group ; in the postoperative 5 days group, the basic characteristic changes was same as the changes of postoperative 3 days bile duct group, but the hyperplasia in whole layers of fibrous tissues was obvious ly and the lumenwas s lightly thickened ; electric coagulat ion necrosis happened in the epithelial cells of 7 days' bile duct injuredby electric heat group, and proliferation occurred in the surrounding connective tissues, the infi ltration of the inflammatory cells were obviouslyand the duct wall was obviously thickened. The epithelial structure of the electric injured bile duct could not be recognized in the operative group of 14 days, hyperplasia of the surrounding connective tissues in the whole layers was predominantly, scattered inflammatory cells infiltration could be seen and the wall of the bile duct was obviously thickened. The average injured range was 3. 86 0. 32 mm. Conclusion The injury caused by electric heat at the wall of the bile duct danages the whole layers, the in juredrange is much larger than that seenwith the naked eye, thefibrosisdegreeof thebileductwall at thedanaged site is gradually increased, the thickness of thewall is gradually increased, the lumen is graduallynarrowedwith the delay of the injured duration.