胆总管探查后内置可降解支架并行Ⅰ期缝合的研究

目的　探讨胆总管 (CBD)探查后内置可降解支架并行Ⅰ期缝合在动物实验中的可行性和临床应用价值。方法　用 160只Wistar大鼠模拟CBD探查术 ,将其随机分为两组 :Ⅰ期缝合组 (对照组 ) ,内置可降解支架后行Ⅰ期缝合组 (实验组 )。观察手术前后大鼠碱性磷酸酶 (ALP)、体重、CBD外径的变化 ;记录缝合时间和总手术时间 ;术后观察胆漏的发生率、支架降解情况 ,并取肝组织做病理学检查。结果　两组在缝合时间、总手术时间及胆漏的发生率上差异无显著性 (P >0 .0 5 ) ;术后第 5周时内支架完全降解 ;对照组术后ALP持续性增高 ,实验组术后ALP一过性增高 ;实验组术后体重较对照组明显增加 ;对照组术后CBD较实验组明显扩张 ;对照组术后肝损伤的发生率 (8/15 )显著高于实验组 (1/15 )。结论　CBD探查后内置可降解支架并行Ⅰ期缝合的方法在动物实验中是较为安全有效的。

Placement of degradable support in common bile duct and primary suture after common bile duct exploration

Objective To study the possible of placement of degradable support in common bile duct (CBD) and primary suture after CBD exploration in rats.Methods In animal model,160 Wistar rats underwent simulated CBD exploration and then were randomized to two groups:primary choledochotomy suture (control group),degradable support inserted in CBD with primary suture (experimental group).The changes in preoperative and postoperative alkaline phosphatase (ALP),weight and CBD diameter were observed.Suture time and operating time was recorded.After operation the incidence of bile leakage and the pathological changes in liver tissue were studied.Results There were no statistical differences between two groups in suture time,operating time and the incidence of bile leakage (P>0.05).The postoperative weight of rats was significantly increased in experimental group as compared with that in control group;In experimental group,rats developed a transient high level of ALP.However,in control group,rats developed a long-term high level of ALP; The postoperative CBD diameter of rats was significantly wider in control group than in experimental group; There were remarkable differences in the pathological changes of liver tissue between control group (8/15) and experimental group (1/15).Conclusion The degradable support placed in CBD with primary suture after CBD exploration is a safe and effective technique in animal experiment.