• 1. 上海第六人民醫(yī)院普外科(上海 200233);;
  • ?2. 南京中醫(yī)藥大學(xué)基礎(chǔ)醫(yī)學(xué)院(江蘇南京 210046);;
  • ?3. 蘇州大學(xué)附屬兒童醫(yī)院普外科(江蘇蘇州 215003);

目的  研究胰膽管合流異常(PBM)膽道損傷的抗氧化治療的效果。
方法  選取13只健康雜種貓,建立PBM動(dòng)物模型后隨機(jī)分為2組:7只不進(jìn)行抗氧化治療(非抗氧化治療組),6只行抗氧化治療(抗氧化治療組);以動(dòng)物建模術(shù)前情況作為對(duì)照。建模術(shù)后飼養(yǎng)6個(gè)月觀察膽囊組織的病理學(xué)改變,檢測(cè)過氧化產(chǎn)物丙二醛(maleic dialdehyde,MDA)的變化情況、PCNA的表達(dá)情況以及膽汁淀粉酶水平。
結(jié)果  13只動(dòng)物建模后均存活6個(gè)月。非抗氧化治療組較正常對(duì)照組膽管增粗,膽囊壁增厚,膽囊內(nèi)膽汁稠厚;抗氧化治療組和非抗氧化治療組相比上述改變無明顯不同。光鏡下見正常對(duì)照組的膽囊黏膜呈指狀,黏膜數(shù)目少,無增生; 非抗氧化治療組的膽囊黏膜增生及炎性細(xì)胞浸潤,部分纖維組織增生。電鏡下見正常對(duì)照組的膽囊黏膜上皮細(xì)胞排列緊密、規(guī)則;非抗氧化治療組膽囊黏膜上皮細(xì)胞的內(nèi)質(zhì)網(wǎng)擴(kuò)張成囊狀,細(xì)胞間隙增寬,細(xì)胞核變形;抗氧化治療組的上述改變較非抗氧化治療組好轉(zhuǎn)。膽汁淀粉酶正常對(duì)照組為(203.02±65.04)?U,非抗氧化治療組為(9 368.09±2 204.42)?U,抗氧化治療組為(8 746.25±2 077.95)?U,后2組高于正常對(duì)照組(P=0.003),但后2組間比較差異無統(tǒng)計(jì)學(xué)意義(P=0.642)。PCNA表達(dá)陽性細(xì)胞所占百分比正常對(duì)照組為(7.29±2.71)%,非抗氧化治療組為(54.71±10.90)%,抗氧化治療組為(48.17±13.06)%,3組間相比差異有統(tǒng)計(jì)學(xué)意義(F=48.11,P=0.001), 其中非抗氧化治療組高于抗氧化治療組(P=0.001)。MDA正常對(duì)照組為(1.095±0.653)?nmol/mg prot,非抗氧化治療組為(2.745±1.533)nmol/mg prot,抗氧化治療組為(1.302±0.771)?nmol/mg prot, 3組間相比差異有統(tǒng)計(jì)學(xué)意義(F=5.17,P=0.017),其中非抗氧化治療組高于抗氧化治療組(P=0.017)。
結(jié)論  抗氧化治療對(duì)PBM有效。

引用本文: 陳風(fēng),湯琳,汪健,黃順根,王興東. 胰膽管合流異常膽道損傷抗氧化治療的實(shí)驗(yàn)研究△. 中國普外基礎(chǔ)與臨床雜志, 2012, 19(10): 1069-1073. doi: 復(fù)制

1. The Jananese Study Group on Pancreaticobiliary Maljunction(JSPBM). Diagnostic criteria of pancreaticobiliary maljunction[J]. J Hep Bil Pancr Surg, 1994, 1(3): 219-221.
2. 陳風(fēng), 汪健, 蔣曉飛, 等. 急性膽源性胰腺炎和胰膽管合流異常的關(guān)系[J]. 肝膽胰外科雜志, 2009, 21(2):98-100.
3. Kamisawa T, Tu Y, Nakajima H, et al. The presence of a common channel and associated pancreaticobiliary diseases:a prospective ERCP study[J]. Dig Liver Dis, 2007, 39(2): 173-179.
4. Dowdy GS Jr, Waldron GW, Brown WG. Surgical anatomy of the pancreatobiliary ductal system. Observations[J]. Arch Surg, 1962, 84(4):229-246.
5. 孟翔凌, 何磊, 徐阿曼. 等. 胰膽管合流異常的臨床意義[J]. 中國普外基礎(chǔ)與臨床雜志, 2003, 10(5):451-453.
6. Otani K, Shimizu S, Chijiiwa K, et al. Immunohistochemical detection of 8-hydroxy-2’-deoxyguanosine in gallbladder epithelium of patients with pancreaticobiliary maljunction[J]. Eur J Gastroenterol Hepatol, 2001, 13(11): 1363-1369.
7. 何平, 石景森, 王作仁, 等. 合并胰膽管合流異常時(shí)膽道疾病的手術(shù)選擇[J]. 中國現(xiàn)代醫(yī)學(xué)雜志, 2002, 12(6): 105-106.
8. Seki M. Yanagisawa A. Ninomiya E. et al. Clinicopathology of pancreaticobiliary maljunction:relationship between alterations in background biliary epithelium and neoplastic development[J]. J Hepatobiliary Pancreat Surg, 2005, 12(3): 254-262.
9. Kobayashi S, Ohnuma N, Yoshida H, et al. Preferable operative age of choledochal dilation types to prevent patients with pancreaticobiliary maljunction from developing biliary tract carcinogenesis[J]. Surgery, 2006, 139(1): 33-38.
10. 陳風(fēng), 呂毅, 汪健, 等. 胰膽管合流異常肝損傷的抗氧化治療實(shí)驗(yàn)研究[J]. 肝膽胰外科雜志, 2011, 23(6): 481-483.
11. Fumino S, Ono S, Kimura O, et al. Diagnostic impact of computed tomography cholangiography and magnetic resonance cholangiopancreatography on pancreaticobiliary maljunction[J]. J Pediatr Surg, 2011, 46(7):1373-1378.
12. Kamisawa T, Takuma K, Itokawa F, et al. Endoscopic diagnosisof pancreaticobiliary maljunction[J]. World J GastrointestEndosc, 2011, 3(1): 1-5.
13. Hori H, Ajiki T, Fujita T, et al. Double cancer of gall bladder and bile duct not associated with anomalous junction of the pancreaticobiliary duct system[J]. Jpn J Cli Oncol, 2006, 36(10): 638-642.
14. 楊蕾, 張斌, 李長鋒, 等. 人胰膽管合流異常膽汁對(duì)膽管細(xì)胞的影響及其機(jī)理探討[J]. 中國普外基礎(chǔ)與臨床雜志, 2007,14(6): 648-651.
15. Watanabe Y, Toki A, Todani T. Bile duct cancer developed after cyst excision for choledochal cyst[J]. J Hepatobiliary Pancreat Surg, 1999, 6(3): 207-212.
16. Kamisawa T, Okamoto A. Biliopancreatic and pancreatobiliary refluxes in cases with and without pancreaticobiliary maljunction:diagnosis and clinical implications[J]. Digestion, 2006, 73(4): 228-236.
17. Kamisawa T, Anjiki H, Egawa N, et al. Diagnosis and clinical implications of pancreatobiliary reflux[J]. World J Gastroenterol, 2008, 14(43): 6622-6626.
18. Kamisawa T, Takuma K, Anjiki H, et al. Pancreaticobiliary maljunction[J]. Clin Gastroenterol Hepatol, 2009, 7(11 Suppl): S84-S88.
19. Shibutani S, Takeshita M, Grollman AP. Insertion of specific bases during DNA synthesis past the oxidation-damaged base 8-oxodG[J]. Nature, 1991, 349(6308): 431-434.
20. Thakor AS, Herrera EA, Serón-Ferré M, et al. Melatonin and vitamin C increase umbilical blood flow via nitric oxide-dependent mechanisms[J]. J Pineal Res, 2010, 49(4): 399-406.
21. Sharma MK, Buettner GR. Interaction of vitamin C and vitamin E during free radical stress in plasma:an ESR study[J]. Free Radic Biol Med, 1993, 14(6): 649-653.
22. Ames BN. Micronutrients prevent cancer and delay aging[J]. Toxicol Lett, 1998, 102(102-103):5-18.
23. Kirsh VA, Hayes RB, Mayne ST, et al. Supplemental and dietary vitamin E, beta-carotene, and vitamin C intakes and prostate cancer risk[J]. J Natl Cancer Inst, 2006, 98(4): 245-254.
24. Martínez-Cruz F, Osuna C, Guerrero JM. Mitochondrial damage induced by fetal hyperphenylalaninemia in the rat brain and liver:its prevention by melatonin, Vitamin E, and Vitamin C[J]. Neurosci Lett, 2006, 392(1-2): 1-4.
25. Factor VM, Laskowska D, Jensen MR, et al. Vitamin E reduces chromosomal damage and inhibits hepatic tumor formation in a transgenic mouse model[J]. Proc Natl Acad Sci U S A, 2000, 97(5): 2196-2201.
  1. 1. The Jananese Study Group on Pancreaticobiliary Maljunction(JSPBM). Diagnostic criteria of pancreaticobiliary maljunction[J]. J Hep Bil Pancr Surg, 1994, 1(3): 219-221.
  2. 2. 陳風(fēng), 汪健, 蔣曉飛, 等. 急性膽源性胰腺炎和胰膽管合流異常的關(guān)系[J]. 肝膽胰外科雜志, 2009, 21(2):98-100.
  3. 3. Kamisawa T, Tu Y, Nakajima H, et al. The presence of a common channel and associated pancreaticobiliary diseases:a prospective ERCP study[J]. Dig Liver Dis, 2007, 39(2): 173-179.
  4. 4. Dowdy GS Jr, Waldron GW, Brown WG. Surgical anatomy of the pancreatobiliary ductal system. Observations[J]. Arch Surg, 1962, 84(4):229-246.
  5. 5. 孟翔凌, 何磊, 徐阿曼. 等. 胰膽管合流異常的臨床意義[J]. 中國普外基礎(chǔ)與臨床雜志, 2003, 10(5):451-453.
  6. 6. Otani K, Shimizu S, Chijiiwa K, et al. Immunohistochemical detection of 8-hydroxy-2’-deoxyguanosine in gallbladder epithelium of patients with pancreaticobiliary maljunction[J]. Eur J Gastroenterol Hepatol, 2001, 13(11): 1363-1369.
  7. 7. 何平, 石景森, 王作仁, 等. 合并胰膽管合流異常時(shí)膽道疾病的手術(shù)選擇[J]. 中國現(xiàn)代醫(yī)學(xué)雜志, 2002, 12(6): 105-106.
  8. 8. Seki M. Yanagisawa A. Ninomiya E. et al. Clinicopathology of pancreaticobiliary maljunction:relationship between alterations in background biliary epithelium and neoplastic development[J]. J Hepatobiliary Pancreat Surg, 2005, 12(3): 254-262.
  9. 9. Kobayashi S, Ohnuma N, Yoshida H, et al. Preferable operative age of choledochal dilation types to prevent patients with pancreaticobiliary maljunction from developing biliary tract carcinogenesis[J]. Surgery, 2006, 139(1): 33-38.
  10. 10. 陳風(fēng), 呂毅, 汪健, 等. 胰膽管合流異常肝損傷的抗氧化治療實(shí)驗(yàn)研究[J]. 肝膽胰外科雜志, 2011, 23(6): 481-483.
  11. 11. Fumino S, Ono S, Kimura O, et al. Diagnostic impact of computed tomography cholangiography and magnetic resonance cholangiopancreatography on pancreaticobiliary maljunction[J]. J Pediatr Surg, 2011, 46(7):1373-1378.
  12. 12. Kamisawa T, Takuma K, Itokawa F, et al. Endoscopic diagnosisof pancreaticobiliary maljunction[J]. World J GastrointestEndosc, 2011, 3(1): 1-5.
  13. 13. Hori H, Ajiki T, Fujita T, et al. Double cancer of gall bladder and bile duct not associated with anomalous junction of the pancreaticobiliary duct system[J]. Jpn J Cli Oncol, 2006, 36(10): 638-642.
  14. 14. 楊蕾, 張斌, 李長鋒, 等. 人胰膽管合流異常膽汁對(duì)膽管細(xì)胞的影響及其機(jī)理探討[J]. 中國普外基礎(chǔ)與臨床雜志, 2007,14(6): 648-651.
  15. 15. Watanabe Y, Toki A, Todani T. Bile duct cancer developed after cyst excision for choledochal cyst[J]. J Hepatobiliary Pancreat Surg, 1999, 6(3): 207-212.
  16. 16. Kamisawa T, Okamoto A. Biliopancreatic and pancreatobiliary refluxes in cases with and without pancreaticobiliary maljunction:diagnosis and clinical implications[J]. Digestion, 2006, 73(4): 228-236.
  17. 17. Kamisawa T, Anjiki H, Egawa N, et al. Diagnosis and clinical implications of pancreatobiliary reflux[J]. World J Gastroenterol, 2008, 14(43): 6622-6626.
  18. 18. Kamisawa T, Takuma K, Anjiki H, et al. Pancreaticobiliary maljunction[J]. Clin Gastroenterol Hepatol, 2009, 7(11 Suppl): S84-S88.
  19. 19. Shibutani S, Takeshita M, Grollman AP. Insertion of specific bases during DNA synthesis past the oxidation-damaged base 8-oxodG[J]. Nature, 1991, 349(6308): 431-434.
  20. 20. Thakor AS, Herrera EA, Serón-Ferré M, et al. Melatonin and vitamin C increase umbilical blood flow via nitric oxide-dependent mechanisms[J]. J Pineal Res, 2010, 49(4): 399-406.
  21. 21. Sharma MK, Buettner GR. Interaction of vitamin C and vitamin E during free radical stress in plasma:an ESR study[J]. Free Radic Biol Med, 1993, 14(6): 649-653.
  22. 22. Ames BN. Micronutrients prevent cancer and delay aging[J]. Toxicol Lett, 1998, 102(102-103):5-18.
  23. 23. Kirsh VA, Hayes RB, Mayne ST, et al. Supplemental and dietary vitamin E, beta-carotene, and vitamin C intakes and prostate cancer risk[J]. J Natl Cancer Inst, 2006, 98(4): 245-254.
  24. 24. Martínez-Cruz F, Osuna C, Guerrero JM. Mitochondrial damage induced by fetal hyperphenylalaninemia in the rat brain and liver:its prevention by melatonin, Vitamin E, and Vitamin C[J]. Neurosci Lett, 2006, 392(1-2): 1-4.
  25. 25. Factor VM, Laskowska D, Jensen MR, et al. Vitamin E reduces chromosomal damage and inhibits hepatic tumor formation in a transgenic mouse model[J]. Proc Natl Acad Sci U S A, 2000, 97(5): 2196-2201.