The Experimental Study Of The Influence Of The Thoracic Duct Drainage On Severe Acute Pancreatitis With Liver Injury

Objective: Severe Acute Pancreatitis (SAP) is a severe acute abdomen surgery emergency, which often occurs with many syndromes and tends to result in multiorgan dysfunction syndrome (MODS).The liver is the body's largest substantive glands organ with rich veins, which is the Centre of substance metabolism as well as a major organ of secretion, excretion, biotransformation and barriers; and is also the place where a variety of synthetic clotting factors are synthesized. As the treatment of Severe acute pancreatitis with liver injury is difficult, the mortality is high.At present, the role of the superior mesenteric - thoracic duct lymph in severe burns and infections such as toxic shock has come to attention and that can be mediated by organ damage caused by its severe infection / trauma.It is found in the clinical and animal experiments that one of the reasons for multiple organ dysfunction syndromes usually is liver damage.Liver is undoubtedly the organ that accepted the mesenteric lymph, which probably causes liver injury .More other studies have shown that the mesenteric lymph collected after shock injures or causes the endothelial cells to death. It boosts the permeability of the cell. Mesenteric lymph drainage can reduce hemorrhagic shock or lung injury after burn.Accordingly, we assumed it may play a similar role in SAP with liver injury as in burns and serious infections.Therefore surgical method is adopted in this experiment to make rat SAP model.By neck fistula caused by surgical puncture through the thoracic duct of rats, tissue and pathological changes of pancreas and liver is observed; the liver function and changes in pancreatic enzyme is determined and indicator changes of blood samples is measured.Experimental basis for guidance of clinical treatment is provided by exploration the impact of neck fistula intervention measures on experimental animals.Methods: 96 maleness healthy SD rats(weight 350-400g) are randomly divided into 4 big groups: sham operation on neck and abdomen group, sham operation on neck and SAP group, thoracic duct fistula and sham operation on abdomen group, thoracic duct fistula and SAP group. Every big group is divided into 3 small groups according to time points of 2h, 6h, 12h.There are 12 small groups in total and every small group includes 8 SD rats.SAP rat models is prepared via retrograde injection of 5% sodium taurocholate to the pancreatic duct, and the tail vein administration route is established. Pancreas and liver organization general observation, measurement of ascites, collecting blood and tissue samples and observation of liver histopathological changes and determination of liver function including ALT, AST, TBLL serum amylase (AMY), lipase (LIP) is all executed by time points set. The concentration change of the TNF-a and IL-10 in serum is measured by enzyme-lined immunosorbent assay. All the experimental data are statistically analyzed by SPSS11.5 software.Results:The change in SAP SD rats :1 Ascites: There are a wealth of red or dark red muddy ascites at each time point. The amount of ascites is between 3ml and 12ml and ascites with significantly increases with time (P <0.01);2 pancreas and liver pathology morphological changes:2.1 general observation: there are varying degrees of congestive pancreatic edema, hemorrhage and black flake necrosis, casual spot in the saponification with SAP group, above condition gradually increase with time;2.2 optical microscopy: Pancreas: there are different degrees of acinar and interstitial edema, hemorrhage and necrosis Flake, pancreatic pathology score significantly increased (P<0.05)with SAP group; liver: Compared with sham operation, liver significantly increases, surface is less smooth, edge gets blunt, the color changes from red to dark brown, soft texture stiffens. Different degrees of liver cell edema, inflammatory cells infiltration in portal area and collagen connective tissue hyperplasia happen. And with time, the situation deteriorates.3 liver function ALT, AST, TBIL ,AMY, LIP changes:Compared with sham operation, ALT, AST, TBIL, AMY, LIP levels are significantly increased, there are significant differences (P <0.01).4 the TNF-a and IL-10 change in serumCompared with sham operation, TNF-a and IL-10 levels are significantly increased. There are significant differences (P <0.01).After the Influence of the Thoracic duct fistula:1 ascites: ascites decreases significantly ;2 pancreas and liver pathology morphological changes:2.1 general observation: pancreatic edema, congestion and the extent of necrosis alleviates, and peripancreatic fat capsule saponification alleviate in varying degrees ,liver doesn't increase obviously, surface is smooth, texture is soft;2.2 light microscope observation: Pancreas: Rats after the intervention have edema and flake hemorrhage mainly .Invasion of inflammatory cells alleviate. The extent of necrosis gets narrow, pancreatic pathology score decreased significantly. Changes in liver pathology reduced. Liver cells edema, inflammatory cells infiltration in portal area and collagen connective tissue hyperplasia reduce significantly;3 liver function indicators ALT, AST, TBIL and AMY, LIP levels are significantly lower (P<0.05);4 TNF-a and IL-10 levels are significantly decreased, there are significant differences (P <0.05).Conclusions:1 SAP rat models is made successfully via retrograde injection of 5% sodium taurocholate to the pancreatic duct. The method of tail vein catheterization rehydration is simple reliable and reproducible. It is a ideal model of SAP preparation methods.2 The liver damage and pathological changes of dysfunction occurrence in SAP, and increase with time. SAP can result in liver damage and pathological dysfunction.3 The concentration of the TNF-a and IL-10 in serum increase in SAP. It indicates that TNF-a and IL-10 are important inflammatory factor in SAP.4 The damage in pancreas and liver has been lightened after the neck fistula intervention.5 After neck fistula intervention, TNF-a levels has been decreased and IL-10 levels has been decreased .It indicates that this intervention saves the liver.