目的：比较胆汁内引流和外引流对胆道梗阻大鼠肝切除术后肝功能及肝再生的影响。方法：将SD大鼠随机分为胆汁内引流组（ID组）、胆汁外引流组（ED组）、对照组，ID组和ED组均行胆总管结扎，对照组行假手术，各组均于术后72 h行部分（70%）肝切除，ID组和ED组同时分别行胆汁内引流与胆汁外引流。分别在肝切除术后0、1、2、3、7 d收集大鼠血清与残余肝组织，检测肝功能指标、肝组织有丝分裂细胞数以及增殖细胞核抗原（PCNA）的表达，并计算各组肝切除术后7 d残肝质量/体质量比值。结果：与对照组比较，ID组和ED组肝切除术后各时间点，血清总胆红素（TBIL）与谷草转氨酶（AST）均明显升高，而白蛋白（ALB）水平明显降低（均P<0.05）；ID组与ED组间比较，除TBIL水平无统计学差异外（均P>0.05），其他两项指标ID组均优于ED组（均P<0.05）。与对照组比较，ID组和ED组核分裂细胞数在肝切除术后大多数时间点均明显降低（均P<0.05），但ID组核分裂细胞数多于ED组，在肝切除术后2、3 d差异有统计学意义（均P<0.05）。肝切除术后，ID组和ED组肝组织PCNA表达量升高的速度与幅度均低于对照组（均P<0.05），ID组升高的程度与衰退的速度大于ED组（均P<0.05）。与对照组比较，ID组和ED组在肝切除术后7 d的残肝质量/体质量比值均降低（均P<0.05），ID组的残肝质量/体重比值明显高于ED组（P<0.05）。结论：胆道梗阻的大鼠部分肝切除术后，胆汁内引流可以改善术后肝功能，促进残余肝脏再生。
Effects of internal and external biliary drainage on liver function and regeneration after hepatectomy in rats with biliary tract obstruction
Objective: To compare the effects of internal and external biliary drainage on liver function and regeneration after hepatectomy in rats with biliary tract obstruction. Methods: SD rats were randomly divided into internal drainage group (ID group), external drainage group (ED group) and control group. Rats in both ID and ED group underwent common bile duct (CBD) ligation, and those in control group underwent sham operation. Rats in each group underwent partial (70%) hepatectomy at 72 h after CBD ligation, and those in ID and ED group had simultaneous internal and external biliary drainage, respectively. The serum samples and remnant liver tissue of the rats were harvested on day 0, 1, 2, 3 and 7 after liver resection, and the liver function parameters, and the number of mitotic cells and expression of proliferating cell nuclear antigen (PCNA) in liver tissues were determined, and the ratio of the remnant liver weight to body weight of the rats on day 7 after liver resection was also calculated. Results: Compared with control group, the serum levels of total bilirubin (TIBL) and aspartate aminotransferase (AST) were significantly increased, but albumin (ALB) level was significantly decreased in both ID and ED group at each time point after liver resection (all P<0.05), while the comparison between ID and ED group, with exception of the TIBL level which showed no significant change (all P>0.05), the other two parameters were better in ID group than those in ED group (all P<0.05). Compared with control group, at most of the time periods, the number of mitotic cells in liver tissues of both ID and ED group were significantly decreased (all P<0.05), which in ID group was higher than that in ED group and was significantly different on day 2 and 3 after liver resection (both P<0.05). Both the speed and amplitude of elevation of the increase of PCNA expression level in control group were greater than those in either ID or ED group (all P<0.05), but increase of amplitude and speed of decline of PCNA expression were greater in ID group than those in ED group (all P<0.05). The ratio of the remnant liver weight to body weight at day 7 after liver resection in either ID or ED group was reduced compared with control group (both P<0.05), but it was greater in ID group than that in ED group (P<0.05). Conclusion: After partial hepatectomy in rats with biliary tract obstruction, internal biliary drainage can improve post-hepatectomy liver function and promote regeneration of the residual liver.