【摘要】 目的　探讨良性胆管狭窄形成机制 .方法　建立犬胆总管损伤修复动物模型后 ,于术后 3d,1 ,3wk,3,6mo取材分别行光镜、电镜观察及免疫组化观察巨噬细胞、转化生长因子 (TGF-β1 )、平滑肌肌动蛋白 (α- SMA)在胆管愈合过程不同时期组织中的表达强度、阳性细胞数和组织分布 .结果　光、电镜显示 :炎性渗出期较长 ,胆道粘膜上皮愈合较慢 ,瘢痕组织细胞持续增生活跃 ,细胞外基质过度沉积 ,胶原纤维排列致密杂乱 .肌成纤维细胞 (MFB)功能活跃 ,持续存在于整个愈合过程中 .免疫组化 :巨噬细胞、转化生长因子 (TGF-β1 )、平滑肌肌动蛋白 (α- SMA)在胆管愈合过程中表达较强 ,且持续较长时间 .MΦ阳性主要表达于胆道粘膜下固有层 ;TGF-β1 主要表达于肉芽组织、成纤维细胞、MΦ及血管内皮细胞胞质和细胞膜 ;α- SMA表达于 MFB质、平滑肌组织 .结论　胆管愈合方式属于过度愈合 ;MFB功能活跃 ,持续存在 ,是导致胆管瘢痕性挛缩的重要原因 ;MΦ、TGF- β1 及 α- SMA高表达是造成胆管愈合过程中成纤维细胞增殖旺盛、细胞外基质过度沉积、胆管瘢痕性挛缩的重要因素更多还原

【Abstract】 AIM To explore the mechanism of benign biliary stricture. METHODS A model of trauma of common bile duct was established in dogs and then the trauma was repaired. Tissues were taken on the 3rd day, 1st week, 3rd week and the 3rd month, 6th month respectively after operation and were studied with light microscopy, electromicroscopy, and immunohistochemical SP staining of macrophage, TGF β 1 and α SMA respectively. RESULTS Light microscopy and electromicroscopy showed that the epithelium of mucosa membrane of bile duct restored poorly, chronic inflammation lasted for a long time, fibroblast proliferated actively and extracellular matrix overdeposited. Thickening arrangement of collagenous fiber was found. Myofibroblasts functioned actively and was observed during the whole healing process. Immunohistochemical test showed a high expression of mycrophage, TGF β 1 and α SMA in the whole healing process and lasted a longer time. Macrophage was found in the intrinsic layer under mucosa, TGF β 1 in the granulation tissue, fibroblast and endothelial cells of blood vessels and α SMA in the myofibroblasts. CONCLUSION The healing of bile duct is in the mode of overhealing. Myofibroblast functions actively and lasts a longer time, which is the main cause for scar contracuture and stricture of bile duct. The high expression of macrophage, TGF β 1 and α SMA is closely related to the active proliferation of fibroblast, extracellular matrix overdeposition and scar contracuture of bile duct.更多还原