膨体聚四氟乙烯补片修复胆管缺损的实验研究

目的 探讨膨体聚四氟乙烯（ePTFE)修复胆管缺损的可能性。方法 36条重庆地区成年犬，通过切除部分胆管壁（A组，14条）、整段切除2－4cm胆总管（B组，10条）和完全结扎胆总管（C组，5条；D组，7条）的方式建立胆管损伤模型，分别采用ePTFE补片修补胆管缺损，管形材料替代胆管，间置材料在胆囊、十二脂肠或空肠吻合修复胆管。观察动物在手术前后的活动状况，结合胆道造影了解胆通畅情况，并在术后3天，2、4、8、12及52周切取胆管修复处的组织，观察胆管组织的变化，不同手术方式对肝脏形态结构的影响。结果 A组采用ePTFE补片修补胆管，胆管上皮能覆盖材料表面，通畅率达75％（9／12），胆汁引流通畅，肝脏无损害；B组通畅率为40％（4／10），伴有不同程度的肝脏形态结构改变；C组和D组的材料均被排除，形成胆囊十二指肠或胆囊空肠瘘。结论 ePTFE补片具有操作简便、通畅率高的特点，可作为修补胆管缺损的材料。

EXPERIMENTAL STUDY ON REPAIR OF BILE DUCT DEFECTS WITH EXPANDED POLYTETRAFLUOROETHYLENE

Objective To explore the possibility of repair of the extensive bile duct injuries with expanded polytetrafluoroethylene (ePTFE). Methods A total of 36 local healthy hybrid dogs were employed to establish bile duct injury models by means of partial removal of bile duct (group A,14 dogs),excision of a segmental duct(group B,10 dogs), and ligation of the lower part of common bile duct(group C,5 dogs; group D,7 dogs). Group A were patched with ePTFE mesh, group B replaced by ePTFE tube. Interposition of the grafts between gallbladder and duedenum or jejunum was performed on group C and group D. The animals' postoperative performance status were evaluated. Cholangiography was used to define the patency of bile ducts. Tissues of bile ducts and liver were taken at 3 days, 2, 4, 8, 12 and 52 weeks for microscopic and ultrastructural examination to observe the healing process of bile duct and morphological changes in the liver. Results Group A with ePTFE patch covered by epithelium had a high patency rate of 75%(9/12) and pathological damages were not found in the liver. The patency rate of group B was merely 40%(4/10), to some extent, accompanying damages in the liver. The grafts of group C and group D were fully expelled, ultimately leading to cystic duodenal or cystic jejunal fistulas formation. Conclusion The study suggests that application of ePTFE patch to repair bile duct defects is feasible.