胆总管急性梗阻时胆道压力胆管扩张黄疸三者的关系

摘要:目的 探讨胆总管急性梗阻时胆道压力、胆管扩张、黄疸三者的关系.方法 犬10条,在十二指肠上缘的胆总管内置入连接自动测压装置系统直经为3.5mm的小管,先测胆道基础压和胆总管直径,然后转开三通开关,通过直经3.5mm小管向胆总管内滴入美蓝盐水(NS 100 ml+美兰60 mg),20滴/min,等于造成胆道梗阻,按结果中显示的时间段测量胆道压力和胆总管直径,并观察美兰染色的胆汁返流至肝脏的情况.结果 滴人美兰盐水前,胆道压力为<8 mm Hg(1 mm Hg =0.133 kPa),胆总管直径为4.0mm,肝脏色泽正常.经3.5 mm测压管向胆管内滴入美兰盐水7 min后,胆道压力上升至15.42 mm Hg,胆总管直径增宽至5.5 mm;15 min后,胆道压力上升至20mm Hg,胆总管直径6mm,肝脏开始变蓝、表示胆管内胆汁巳向肝内染色返流;30 min后,胆道压力上升至34 mm Hg,胆总管直径6.7mm,肝脏美蓝染色加深;45 min后,胆道压力21 mm Hg,胆总管直径7.5 mm,肝脏呈深蓝色;60 min后,胆道压力18 mm Hg,胆总管直径7.5 mm.结论 胆道压力升高后先有胆管扩张,后有黄疸;在一定范围内,胆管扩张程度与胆道压力呈正相关;黄疸程度与胆道压力和胆管扩张程度呈正相关.但胆道压力上升至34 mm Hg时不再升高,胆管扩张至7.5mm时不再扩张,表明胆道压力和胆管扩张均有一定的自限度.
Objective To investigate the relationship between the pressure,diameter,and jaundice in acute obstruction of the common bile duct (CBD).Methods An automatic pressure measurement device was placed through a small tube (D =3.5 mm) into the CBD on the upper entrance of the duodenum.The pressure and diameter of the CBD were detected.The switch was then turned on and methylene blue (MB) in saline (NS 100 ml+ MB 60 mg,20 drops/min) was infused into the CBD to create CBD congestion.The pressure and diameter were detected according to the time set,and the reflux of MB to the liver was observed.Results Before the MB was injected,the pressure of the CBD was hower than 8 mm Hg ( 1 mm Hg =0.133 kPa),the diameter was 4.0 mm,and the color of the liver was normal.Seven min after the MB was introduced,the pressure was increased to 15.42 mm Hgand the diameter widened to 5.50 mm.Fifteen min after introduction the pressure was increased to 20 mm Hg and the diameter widened to 6.00 mm,the liver surface began to turn blue,indicating that the bile had begun to reflux into the liver.After 30 min,the pressure was increased to 33 mm Hg,the diameter widened to 6.7 mm,and the blue liver color enhanced.After 45 min,the pressure was increased to 21 mm Hg,the diameter widened to 7.5 mm,and the color of the liver was dark blue.After 60 min,the pressure was increased to 18 mm Hg and the diameter widened to 7.5 mm.Conclusion After the pressure rises,increase in the diameter is observed,followed by jaundice.Within a certain range,bile duct dilatation is positively correlated with the biliary pressure.The degree of jaundice and biliary duct dilatation pressure are also positively correlated.However,when the biliary pressure rises to 33 mmHg,it no longer increases,while the expansion of the width to 7.5 mm also no longer continues,indicating that duct dilatation and pressure are both self-limiting.

英文标题Correlation among pressure, diameter, and jaundice in acute obstruction of common bile duct
关键字胆总管急性梗阻,胆道压力,胆管扩张,黄疽
作者吕云福,王保春,官晓光,韩晓玉,张世杰,刘宁,翁少文
所属期刊栏目胆道外科,Biliary Surgery
刊名中华实验外科杂志,Chinese Journal of Experimental Surgery
作者单位王保春:海南省人民医院,张世杰:广东开平市中心医院,翁少文:海南省人民医院,官晓光:海南省人民医院,吕云福:海南省人民医院,刘宁:海南省人民医院,韩晓玉:海南省人民医院
DOI10.3760/cma.j.issn.1001-9030.2011.11.011
SSSN1001-9030

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