胆道损伤一期修复术后是否需留置T管的实验研究

Experimental research of whether to indwell T-tube after one-stage prosthesis operation of bile duct damage

目的妥善处理已经发生的胆道损伤,最大限度地减少再手术。方法切开兔胆管并自十二指肠乳头行胆管内支撑方法建立模型,将不同时期梗阻段胆管壁进行V.G染色和β1型转化生长因子(transforming growth factor beta1,TGF-β1)免疫组化染色,测定TGF-β1阳性区域的光度以及胆管组织胶原含量积分光密度随时间变化关系。结果兔胆管壁TGF-β的含量随着时间延长逐渐增加,在60d左右达到最高值,以后逐渐减少,在90～120d接近正常水平,胶原组织积分光密度对比在30d内未放置导管组与放置导管组差异有统计学意义(P=0.009),60d后差异无统计学意义。结论严格选择适应证及精细的手术操作,胆总管损伤一期修复后不放置T管是安全可行的。评价治疗过程和方法是否合理的客观标准是治疗手段能否恢复胆道系统的完整性和通畅性。

Objective To treat the bile duct damage in a proper way to reduce the re-operations as much as possible. Methods The bile duct of rabbit was excided and a pipe supporting bile duct was inserted through duodenal major papilla to establish a model. V.G staining and TGF-beta 1 immunohistochemistry staining on tubal wall of rabbit bile duct in different times were used to determine quantitatively the intensity of light TGF-beta 1 positive area and the relationship between the integral-optical density of bile duct tissue collagen content and time. Results The content of TGF-beta 1 in bile duct tissue increased with the prolongation of time. about 60 days reaching the Max., then decreasing gradually, about 90-120 days reaching the normal standard. Constrasting the integral-optical density of collagen tissue, the numbers of pipe-indwelling group were higher than those of non-pipe-indwelling group, especially in 30 days, Conclusion It is feasible and safe not to indwell T-tube after the one-stage prosthesis operation of bile duct damage. The objective standard judging the rationality of the process and method of operation are whether this treatment can keep recover the integrity and smoothy of biliary system through the one-stage prosthesis operation of bile duct damage.