胃胆管引流拔管时间的研究  

The experimental study on the time of removal of gastrobiliary duct drainage in primary suture af- ter exploration of common bile duct in dog

作　　者：戴赛民[1] 陈青[2] 张勇[1] 郭子健[1] 吴二斌[1] 过建工[1] 

机构地区：[1]无锡市第四人民医院肝胆外科,214062 [2]复旦大学附属中山医院肝外科肝癌研究所

出　　处：《中华实验外科杂志》2013年第7期1450-1452,共3页Chinese Journal of Experimental Surgery

基　　金：无锡市科技局课题项目（HS20030011）

摘　　要：目的建立胆总管探查、胃胆管引流、胆总管一期缝合的动物模型，探讨安全拔除胃胆管的时间，指导临床拔除胃胆管。方法将25条犬随机分成对照组（仅行腹腔探查，n：5）与胃胆管引流、胆总管一期缝合组（简称胃胆管组，n=20），实验组按术后3、5、7、9d经胃胆管胆道造影并拔除，随机分为4组；取吻合处胆管作苏木素一伊红（HE）染色、Masson染色、扫描电镜。结果实验组术后3、5、7、9d经胃胆管胆道造影并拔除。拔除胃胆管后，3d组2例胆漏，余实验组无1例胆漏。实验组胆管平均黏膜炎症指数：术后3d与5、7、9d比较差异有统计学意义（3．20±0．45比2．20±0．45、1．40＋0．55、1．20±0．45，P〈0．05），术后7d比9d差异无统计学意义（P〉0．05）。实验组胆管平均黏膜愈合指数：术后3d与5、7、9d比较差异有统计学意义（1．00比2．20±0．45、2．40±0．55、2．80±0．45，P〈0．05），术后5、7、9d差异无统计学意义（P〉0．05）。术后5—7d，HE染色见胆管壁明显增厚；Masson染色见胆管壁大量胶原纤维增生、排列杂乱；扫描电镜见部分胆管内壁重新由上皮细胞覆盖。结论胃胆管引流术后5—7d，可安全拔除胃胆管，拔管后无1例胆漏。Objective To establish an animal model with installation of gastrobiliary duct drainage （GBDD） in primary suture after exploration of common bile duct, to investigate the natuaral history of the healing of bile duct and obtain the safety, appropriate time of removal of GBDD. Methods Twenty-five dogs were randomly divided into control group （ n = 5 ） and GBDD group （ n = 20）. The GBDD group was randomly divided into four subgroups, to cholangiography, extubate, and then excised bile duct anastomoses were stained with hematoxylin and eosin （ HE）, Masson and Scanning electron microscope （SEM） on post- operative day （POD） 3,5,7,9 respectively. Results Two bile leakage cases were found in POD 3 group after removal of the GBDD, no bile leakage case was fund in other groups. The inflammatory cell infiltration of the bile duct anastomoses showed statistical significance among four groups on POD 3 vs 5,7,9 （3.2 -± 0.45 vs 2. 2 ± 0. 45,1.4 ± 0. 55,1.2 ± 0. 45, all P 〈 0. 05 ）. POD 7 vs 9 showed no statistically significant difference between them （ P 〉 0. 05 ）. There were significant difference in index of mucosal healing among POD 3 vs 5,7,9 （ 1.0 vs 2. 2 ±0.45,2.4 ±0. 55,2. 8 ±0. 45 ,all P 〈0. 05） ,POD 5,7,9 showed no statis- tically significant difference among them （ P 〉 0. 05 ）. POD 5-7, HE staining showed that bile duct wall was thickening;Masson staining showed that the fibroblast distribution was disorderly;SEM showed that port of the bile duct restored with epithelial cell. However, the mucosa of bile duct restored poorly, chronic inflam- mation lasted for a long time. Conclusion It is safe to remove the GBDD on POD 5-7,there was no bile leakage.

关 键 词：胃胆管引流 一期缝合 拔管时间 

分 类 号：R657.4[医药卫生—外科学]