应用可降解腔内支架的无缝合吻合术在狗胆肠吻合模型的实验研究

目的 传统的手工缝合行胆肠吻合术操作困难、费时，尤其在小胆管吻合和腹腔镜手术时明显。为简化和改良手术操作，我们设计了一种新的应用可降解腔内支架的无缝合胆肠吻合术。本文拟在狗胆总管十二指肠吻合模型中评估该无缝合方法的可行性和安全性。方法 为无缝合胆总管十二指肠吻合术设计一种腔内吻合支架管，这种专利支架管直径3mm和4mm,材料为可降解聚乳酸。38条毕格犬随机分为支架组（SG n=20）和对照组（CG n=18）。SG组应用无缝合支架法行胆总管十二指肠端侧吻合，CG组行传统可吸收缝线间断一层胆总管十二指肠端侧吻合。动物分术后1、3、6、12月4个亚组，比较两组术中吻合手术时间、术中吻合口耐受压、胆漏发生率、术后吻合口爆破压差异，观察两组术后胆红素和肝酶变化、术后1，3，6，12月取材的吻合口组织病理形态学改变，包括HE染色和Masson染色，比较两组吻合口羟脯氨酸含量，观察两组吻合口疤痕纤维组织增生状况。MRCP了解术后6月，12月两组吻合口状况。结果 手术均顺利完成，支架组吻合时间明显小于对照组(SG19.2±4.3min VS CG29.2±7.1min, P 0.000)；两组各有1例胆漏并死亡（SG5.0% VS CG 5.6%，P=0.695)。两组间术中吻合口耐受压、术后胆漏发生率、术后各时期吻合口爆破压、吻合口羟脯氨酸含量、胆红素和肝酶测定均无显著性差异。MRCP检查及病理检查未发现吻合口狭窄和梗阻。结论 在狗胆总管十二指肠吻合模型中，无缝合腔内可降解支架胆吻合方法具有可行性和安全性。

Experimental investigation of sutureless choledochoduodenostomy with an intraluminal degradable stent in dog model

Background It is difficult and time-consuming for carrying out conventional hand-sewn bilioenteric anastomosis,especially for small bile duct anastomosis and laparoscopic procedure.In order to simplify it,we have developed a novel procedure of sutureless bilioenteric anastomosis with an intraluminal degradable stent. This study is to evaluate the feasibility and safety of this technique with cholangioduodenostomy in dog model. Methods A patent intraluminal degradable stent tube for sutureless choledochoduodenostomy in dog model was made with polylactid acid in diameter of 3mm or 4mm.Thirty eight dogs were randomly divided into to a stent group (n = 20) and a control group (n=18). Dogs in the stent group (SG) underwent sutureless choledochoduodenostomy with intraluminal stent, while the control group (CG) underwent conventional choledochoduodenostomy (single layer discontinuous anastomosis with absorbable suture). Dogs of each group were divided into 4 subgroups according to time of death (month1, 3, 6, and 12 postoperatively) to evaluate the healing of anastomosis. Operation time, intraoperative tolerance pressure of anastomosis, rate of postoperative bile leakage,bursting pressure of anastomosis were compared between the two groups. Anastomosis tissue was observed afterwards by pathology evaluation, hydroxyproline content, serum bilirubin, liver enzyme level and magnetic resonanced cholangio-pancreatography (MRCP) to assess the stricture. Results All procedures were completed successfully. The surgical time of the stent group was significantly less than the control group (SG19.2±4.3min VS CG29.2±7.1min, P 0.000). One bile leakage was occurred in either group. No significant difference of intraoperative tolerance pressure of anastomosis, rate of bile leakage and postoperative bursting pressure of anastomosis, anastomotic stricture,hydroxyproline content, serum bilirubin and liver enzyme level was found between the groups. MRCP, serum bilirubin and liver enzyme level showed no anastomosis stricture and obstruction during months follow-up. Conclusion The technique of sutureless choledochoduodenostomy with a degradable intraluminal stent is feasible and a safe procedure in this dog model.