激光辅助焊接大白鼠胆总管的实验研究

Comparison of Laser-assisted Welded and Sutured Repair of Common Bile Duct in Wistar Rat Model

目的 :研究激光辅助焊接和传统外科缝合在胆总管修复中的可行性。方法 :将 40只Wistar鼠分为激光焊接组 (n =2 0 )及线缝合组 (n =2 0 )。胆总管切断后 ,分别行激光辅助焊接及线缝合。记录吻合时间 ,测量术前及术后 1 4d胆总管外径 ,记录胆漏的发生率 ,肝脏及胆总管吻合口于 0d、3d、7d、1 4d、2 8d行组织学检查。结果 :横断组激光焊接平均时间 ( 1 8.0min)明显快于缝合组 ( 5 4 .6min)。激光焊接组胆总管外径术前及术后分别为 ( 1 .0 9± 0 .0 9)mm、( 1 .65± 0 .43)mm ,P <0 .0 5 ;缝合组为 ( 1 .1 0± 0 .0 6)mm、( 1 .76± 0 .37)mm ,P <0 .0 5 ,激光焊接组与线缝合组比较P >0 .0 5。胆漏发生率分别为 1 /1 0及 6/1 0 ,P <0 .0 5 ,而肝脏损害经病理证实分别为 1 /1 0及 2 /1 0 ,P >0 .0 5 ;组织学检查显示术后 2 8d ,激光焊接和线缝合比较 ,胆总管的内膜已修复 ,炎症反应轻 ,无明显肉芽肿形成 ,纤维瘢痕细小。结论 :激光焊接胆总管在实验阶段是可行的 。

Objective:It have been reported that the advantages of laser-assistaned microvascular anastomoses (LAMA) is exact, however, whether repairment of common bile duct (CBD) by laser is advantageous is not yet known. The aim of this study is to compare the effect of CBD repairment by laser welding with the conventional microsuture repairment. Method:The 40 adult wistar rats were randomly divided into two groups. In Group 1(n=20):rats had their CBDs transected and repaired using CO 2 laser welding(600mv, 0.25mm spot size)with three triangulated stay sutures; Group 2 (n=20): rats had their CBDs transected and repaired by conventional microsuturing technique with 8～12 stitches at equal intervals (polypropylene sutures 11/0). Evaluating parameters include bile leakage rate, preoperative CBD diameter, postoperative diameter after 14 days (n=10), operating time and histology days0, 3, 7, 14 and 28). Results:In groups of CBDs transected, there were definitive statitical differences in operative time, bile leakage rate (P<0.05). Nevertheless, significant differences were not found in biliary dilation and liver damage (P>0.05). Histological evaluation at 28th day revealed less fibrosis in laser-repaired CBD than that in suture. Conclusion:The findings suggest that laser repair of CBD is superior to suturing and may become a promising alternative in clinical practice.