自体游离腹膜修复胆管缺损的实验研究

目的探讨自体游离腹膜修复胆管缺损的可行性，为临床上胆管缺损的修复提供理想的材料。方法①24条体重为8～12kg的健康杂种犬，经开腹手术切除部分胆管管壁，长0．8～1．0cm，宽为周径的1／3～2／3，建立胆管缺损模型。切取较缺损稍大的一块壁层腹膜，浆膜面对胆管腔，间断缝合于胆管缺损边缘，外用大网膜覆盖并固定。②术后4周、8周、12周、28周、52周分别取4条实验犬，切取肝组织及修复段胆管行光镜检查，观察肝脏及胆管组织的形态结构变化。③术后26周、50周行胆管造影。结果①4条实验犬死亡，其余20条实验犬均健康存活，直到实验预定结束日期。②28周后修复段胆管腔面有单层柱状上皮覆盖，胆管壁结构与正常基本相似。肝组织结构无明显异常。③术后胆道造影显示，除1条实验犬于术后26周显示胆总管有局限性狭窄外，其余均未发现胆管有明显狭窄。结论腹膜因其来源广泛、分化程度低、容易存活、抗感染能力强等特点，可作为胆管缺损的自体修复材料。大网膜的覆盖有利于游离腹膜血循环的早期建立。

An experimental study on repair of bile duct defect with free peritoneal graft

Objective To explore the feasibility of using autogenous free peritoneal graft for repair of the bile duct defect and to find an ideal material for the clinical management of the bile duct injury. Methods 1) Twenty-four local healthy mongrel dogs weighting 8-12 kg underwent right rectus abdominal laparotomy and had 0.8-1.0 cm of the anterior one-third to two-thirds of their bile duct resected to establish the model of bile duct injury. The parietal peritoneal flap was harvested near the abdominal incision with the similar dimension of the bile duct defect and sutured to the edges of the excised bile duct with the coverage of omentum outside. 2) Laparotomy was performed again at following intervals: 2 weeks (n=3, died), 4 weeks (n=4), 8 weeks (n=4), 12 weeks (n=4), 28 weeks (n=4) and 52 weeks (n=4). The tissues of liver and common bile duct, especially the repaired segment, were harvested for light microscopic examination to observe the healing process of bile duct and morphological changes in liver. 3) Cholangiography was performed at 26 and 50 weeks after operation. Results 1) Four dogs died and the other 20 were healthy at the time of killing with normal appetite and body weight without jaundice. 2) Microscopic examination showed that the repaired segment was completely occupied by biliary epithelium after 28 weeks, and the bile duct wall was similar to the normal canine common bile duct. The liver had no pathological damages. 3) The cholangiography showed that the lumen remained of normal caliber, and there were no signs of biliary dilation or stricture in spite of 1 stricture at 26 weeks. Conclusions Free autogenous peritoneum can be used for regeneration of bile duct tissue in a canine model because of such advantages as abundance, potential ability of regeneration, antibacterial effect, convenience and so on. The covering omentum can help the early reconstruction of blood vessels.