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

雄性Wistar大鼠，体重280~310g，麻醉后剖腹。将聚乙烯导管放置并捆绑在左叶胆管(相当于肝脏的70%)。注射无水乙醇0.2mL20~25s。这一剂量的乙醇是基于胆道造影术的结果。未灌注肝叶重量增加，术后第14天增加1.6倍，Ki-67标记指数在术后第1天升高，而注射乙醇的肝叶重量在术后第14天下降到不到全肝重量的50%。光镜下，注入乙醇的肝叶第1天的小叶间胆管被破坏，分布于肝叶内。然而，门静脉和肝动脉在结构上保存良好。乙醇浸透Glisson‘s囊，破坏肝细胞，肝细胞在第14天被纤维组织和增殖的胆管取代，无肝脓肿。未灌注叶的胆汁流量和胆汁酸排泄量在第3天显著增加，并在第14天达到原值的两倍以上。相反，这些变量在第3天显著减少，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无严重并发症的肝内胆管输注，达到叶萎缩的消融效果，并造成对侧肥大。我们使用这种干预措施来治疗胆道切除后的一次重大胆漏。在手术过程中，患者抱怨面色发红，但没有疼痛。CT显示灌注肝段萎缩，无肝脓肿，非灌注肝段代偿性肥大。此外，我们对其他三名患者进行了这种干预，可以达到目的，没有任何严重的并发症。

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.