胆总管端端吻合自然愈合过程的实验研究  

THE EXPERIMENTAL STUDY ON THE NATURAL HEALING PROCESS OF COMMON BILE DUCT END-TO-END ANASTOMOSIS

作　　者：陈青[1] 吴二斌[1] 郭子健[1] 戴赛民[1] 张勇[1] 过建工[1] 周鹏[1] 周俊晶[1] 

机构地区：[1]苏州大学附属第四医院肝胆外科,无锡214000

出　　处：《肝胆外科杂志》2011年第3期229-231,237,共4页Journal of Hepatobiliary Surgery

基　　金：无锡市科技局课题(HS20030011)

摘　　要：目的建立犬胆总管横断损伤、胆道支架管引流、胆总管端端吻合的动物模型,探讨胆总管端端吻合的自然愈合过程。方法将25只犬随机分成对照组(n=5)与实验组(n=20),实验组分为4组,于术后3 d5、d、7 d9、d,胆道造影、取吻合处胆总管作羟脯氨酸、断裂强度、HE染色、Masson染色检测。结果实验组术后无一例胆漏;羟脯氨酸(mg):术后第3 dvs 5 d7、d、9 d、对照组差异有统计学意义(9±1.87 vs 20.6±2.302、2.6±2.70、27±4.121、6.54±2.22,均P<0.05),术后第5d vs 7 d差异无统计学意义(P=0.265)。断裂强度(N):术后第3 d vs 5 d、7 d、9 d差异有统计学意义(2.5±0.94 vs 5.72±1.057、.76±0.72、8.68±0.92,均P<0.05),术后第7 d vs 9 d差异无统计学意义(P=0.131)。术后5～7 d,HE染色见胆管壁增厚;Masson染色见大量胶原纤维增生、排列杂乱。结论胆总管横断损伤、胆道支架管引流、胆总管端端吻合术后,胆管壁胶原含量、断裂强度迅速升高,术后5～7 d,接近正常胆管组织水平;胆管壁增厚、胆管壁胶原纤维增生。Objective Establishment of transection injury of dogs＇common bile duct with installation of stents insertion,end-to-end anastomosis.To investigate the natuaral history of the healing of common bile duct.Methods Twenty-five dogs were randomly divided into two groups： control group（n=5） and experimental group（n=20）.Experimental group was randomly divided into four groups,to cholangiography and then each group was sacrificed on POD（postoperative days） 3,5,7,9 respectively.Excised anastomsis tissue were examined for breaking strength、collagen content and observed with light microscope.Results No bile leakage case was fund in experimental groups.There was statistical significance in terms of HP content（mg） among the four groups and control group anastomoses,POD 3 vs 5、7、9、control group（9±1.87 vs 20.6±2.30,22.6±2.70,27±4.12,16.54±2.22,all P0.05）,POD 5 vs 7 showed no difference between them（P=0.265）.There were statistical significance in Breaking Strength（N） among the four groups anastomoses,POD 3 vs 5,7,9（2.5±0.94 vs 5.72±1.05,7.76±0.72,8.68±0.92,all P0.05）,POD 7 vs 9 showed no difference between them（P=0.131）.POD 5-7,HE staining showed that bile duct wall was thickening;Masson staining showed that bile duct wall was fibroblast proliferatingactively,distribution mixed and disorderly.Conclusions The present study on dogs＇common bile duct showed that the collagen content、breaking strength increased rapidly and approached even exceeded the normal levels on POD 7.On this time,the common bile duct wall was thickening and fibroblast proliferatingactively,distribution mixed and disorderly.

关 键 词：医源性胆管损伤 一期缝合 断裂强度 胶原含量 伤口愈合 

分 类 号：R657.3[医药卫生—外科学]