An experimental and clinical study of selective intrahepatic biliary ablatron with absolute ethanol

体重280 ~ 310 g的雄性Wister大鼠麻醉，开腹。在左叶（相当于肝脏的70%）胆管内放置并绑上聚乙烯导管。注射无水乙醇0.2 mL，持续20-25秒。乙醇的剂量根据胆道造影结果确定。术后未灌注肺叶重量增加，第14天重量增加1.6倍，第1天Ki-67标记指数升高。与此相反，在第14天，注入乙醇的肝叶重量下降到全肝重量的50%以下。镜下观察，第1天灌注的肝叶小叶间胆管被破坏，在肝叶内均匀可见。门静脉和肝动脉在结构上保存完好。乙醇浸透Glisson囊，破坏肝细胞，第14天肝细胞被纤维组织和增殖的胆管所取代，无肝脓肿。在第3天，未灌注肝叶的胆汁流量和胆汁酸排泄量均显著增加，到第14天，胆汁流量和胆汁酸排泄量增加了一倍以上。相反，这些变量在注射后第3天急剧下降，第14天几乎为零。从这些观察中，我们得出结论，选择性肝内胆道输注最佳剂量的乙醇可以安全地进行，没有严重的并发症，实现萎缩的大叶消融效果，并造成对侧肥厚。我们使用这种干预措施治疗肝胆道切除术后的主要胆汁泄漏。在手术过程中，病人抱怨脸红，但没有疼痛。CT显示灌注肝段萎缩，无肝脓肿，未灌注肝段代偿性肥大。此外，我们将该干预应用于其他3例患者，均能达到目的，无严重并发症。

Male Wister rats weighing 280-310 g were anesthetized and the abdomen was opened. A polyethylene catheter was placed and tied in the bile duct of the left lobes (equivalent to 70% of the liver). 0.2 mL of absolute ethanol was injected for 20-25 sec. This dose of ethanol was based on the finding of cholangiography. The weight of the noninfused lobes increased after surgery and reached a 1.6-fold increase by day 14, with the increased level of the Ki-67 labeling index on day 1. In contrast, the weight of the ethanol-infused lobes decreased to less than 50% of the entire liver weight by day 14. Microscopically, the interlobular bile ducts of the infused lobes on day 1 were destroyed, which was uniformly found in the lobes. However, the portal veins and hepatic arteries were structurally well preserved. Ethanol soaked through Glisson's capsule and destroyed hepatocytes, which were replaced by fibrous tissue and proliferating bile ductules without liver abscess on day 14. Both bile flow and bile acid excretion of the noninfused lobes significantly increased on day 3 and became over twice the original values by day 14. In contrast, these variables decreased dramatically in the infused lobes on day 3 and were nearly zero on day 14.From these observations, we concluded that selective intrahepatic biliary infusion of an optimal dose of ethanol can be performed safely without serious complication, achieving a lobar ablation effect with atrophy and creating contralateral hypertrophy.We used this intervention to treat a major bile leak after bepatobiliary resection. During the procedure, the patient complained about flushing but not pain. CT demonstrated atrophy of the infused hepatic segment without liver abscess and compensatory hypertrophy of the noninfused segmens. Furthermore, we applied this intervention to other three patients and could accomplish purposes without any serious complications.