肝门空肠吻合可行性的动物实验研究  

Feasibility study of portojejunal anastomosis in beagle canine

作　　者：程家浩[1] 吉敏[1] 徐冰心[2] 周英豪[1] 王卫[1] 任鸿昌[1] 李成林[1] 

机构地区：[1]中国人民解放军第306医院普外科,北京100101 [2]中国人民解放军第306医院特种病科,北京100101

出　　处：《腹部外科》2013年第6期418-422,共5页Journal of Abdominal Surgery

摘　　要：目的 研究肝门空肠直接吻合后吻合口的愈合牢固程度、组织学改变及术后并发症发生情况.方法 以比格犬为对象进行肝门空肠直接吻合,按术后不同观察时间分为1个月组和3个月组,每组6只.分别于术前,术后1 d、3 d、1周、2周、1个月（和3个月）进行肝功能检测.术后1个月、3个月按组处死动物,观察腹腔内有无出血、感染、吻合口漏等情况及胆管有无狭窄及闭塞,并测定吻合口爆破压.取吻合口、吻合口内胆管及肝脏做组织学检查,苦味酸-天狼猩红染色观察吻合口组织Ⅰ、Ⅲ型胶原纤维的分布与特征,并对图像进行分析,计算每张照片中Ⅰ、Ⅲ型胶原含量及Ⅰ型胶原比例.结果 术后1个月肝肠吻合口平均爆破压为（33.65±7.15）kPa,肠肠爆破压为（40.31±5.47）kPa;术后3个月肝肠吻合口平均爆破压为（32.67±5.93）kPa,肠肠爆破压为（38.55±7.76）kPa;肝肠吻合口在术后1个月、3个月与肠肠吻合口的爆破压差异均无统计学意义（P〉0.05）.HE染色：肝肠两种组织愈合良好,吻合口可见胶原纤维伴有毛细血管增生,形成肉芽组织.胆管管腔无狭窄,近端肝内胆管未见明显扩张.1个月组肝肠吻合口和肠肠吻合口总胶原含量分别为1.47E4±7.90E3、1.62E4±1.20E4（P〉0.05）,Ⅰ型胶原占总胶原百分比分别为（9.33E1±5.23E）0%、（9.21E1±6.47E）0%（P〉0.05）.3个月组中肝肠吻合口和肠肠吻合口总胶原含量分别为1.39E4±9.29E3、1.65E4±1.14E4（P〉0.05）,Ⅰ型胶原占总胶原百分比分别为（9.30E1±5.83E0）%、（9.15E1±6.91E0）%（P〉0.05）.结论 肝门空肠吻合术后吻合口愈合良好,并具有足够的愈合牢度,手术并发症少,可作为胆肠吻合的一种补充术式应用于临床.Objective To study the feasibility of portojejunal anastomosis in beagle canine. Methods Twelve clean-grade beagle canine were selected randomly. After the direct anastomosis of hepatic portal and jejunum was made, the animals were divided into one-month and three-month groups. The liver functions were tested at preoperative day 1, and postoperative day 1, day 3, l% week, 2na week, 1St month or 3td month. The animals were sacrificed at 1st month or 3%a month respec- tively to observe the intra-abdominal bleeding, infection, anastomotic leakage, and bile duct stenosis, as well as the occlusion. The burst-force of liver and intestinal anastomosis stoma was measured. The tissues from the anastomosis stoma, liver and bile duct were collected for histological examination. Picric acid-Sirius red staining was applied in anastomotic stoma tissues. Distribution and characteristics of type I and [11 collagen fibers were analyzed with the Pro-plus5.1 image processing software： type %[ and type IlI collagen content; type I collagen ratio of the total collagen. Results The average burst-force of portojejunal anastomosis stomas at first month after surgery was 33. 65 ± 7. 15 kPa, and the intestinal anastomis stoma burst-force was 40. 31 ± 5.47 kPa; at 3rd month after surgery the aver age burst-force in portojejunal anastomosis stoma was 32. 67 ± 5.93 kPa, and intestinal anastomosis stoma burst-force was 38.55 ± 7. 76 kPa. There was no significant difference between l%t month group and 3＇d month group （P）0. 05）. HE staining revealed the tissues healed well, collagen fibers around capillary proliferation could be seen at the anastomosis stoma, and granulation tissue formed gradual-ly. No bile duct lumen stenosis and significant expansion of the proximal intrahepatic bile duct were observed. Picric acid-Sirius red staining showed the collagen distribution at portojejunal anastomosis stoma and intestinal-intestinal anastomosis stoma in 1 ~ month group was l. 47FA ± 7. 90E3 and 1.62FA ± 1.20E4 respectively （P^0. 0

关 键 词：胆管肠吻合处 肝 胶原 动物实验 

分 类 号：R656.61[医药卫生—外科学]