犬胆总管内置可降解支架并行激光焊接的安全性及胆总管组织学变化

目的：探讨犬胆总管(CBD)探查后内置可降解支架并行激光焊接的可行性及其临床应用价值。方法：用30条本地杂种犬模拟胆总管探查术（CBDE）,将其随机分为3组:单一激光焊接组（对照组Ⅰ，n=10），CBD内置可降解支架后行I期缝合组（对照组Ⅱ，n=10），以及CBD内置可降解支架后行激光焊接组（实验组,n=10）。观察各组手术前后CBD内径的变化，记录缝合时间和总手术时间, 观察术后1～3 d胆漏的发生率、支架降解情况,术后6周取胆总管及肝组织做病理学检查。结果：对照组Ⅰ术后胆漏的发生率（6/10）显著高于实验组（0/10）和对照组Ⅱ（0/10）；对照组Ⅱ的缝合时间［(7.20±2.88)min］多于实验组［(2.02±1.03)min］。术后第6周胆总管及肝组织病理学显示，实验组胆总管的内膜已修复，炎症反应轻，无明显肉芽肿形成，部分焊接区域几乎无纤维瘢痕，明显优于对照组Ⅱ；对照组Ⅱ与实验组术后均无肝损伤表现，CBD内径均无增宽或变窄。结论：胆总管探查术后内置可降解支架并行激光焊接的方法在动物实验中是安全有效的,且优于线缝合组。

Feasibility of placing degradable stent in CBD and laser welding after CBDE in dogs and histological changes of CBD

Objective To study the feasibility of placing degradable stent in common bile duct(CBD) and laser welding after CBD exploration(CBDE) in dogs and its clinical values.Methods 30 dogs underwent simulated CBDE were randomly divided into 3 groups:single laser welding(comparative group Ⅰ,n=10),degradable stent inserted in CBD with primary closure(comparative group Ⅱ,n=10),degradable stent inserted in CBD with laser welding(experimental group,n=10). When stent didn′t appeared on the radiograph,the dogs were sacrificed.Evaluating parameters included: pre-operative and post-operative CBD diameters,operation time,bile leakage rate,pathological examinations of liver and CBD tissues 6 weeks after operation.Results The bile leakage rate was significantly higher in comparative groupⅠthan those in experimental group and comparative group Ⅱ.There was an obvious statistical difference in operation time which was longer in comparative group Ⅱ than that in experimental group.Compared with(comparative) group Ⅱ,the post-operative pathological examination of CBD in experimental group showed that bile mucosa had been repaired entirely,less inflammatory,smoother healing and less scar formation.There were no statistical differences between experimental group and comparative groupⅡ in terms of pathological examination of liver tissue and change of CBD diameter.Conclusion The degradable stent placement after CBDE and the laser welding of CBD is a safe and more effective technique adjunct to CBDE.The method is superior to primary closure.