摘要
目的:探讨早期扩张经皮肝胆道镜手术瘘道的可能性,以缩短经皮肝胆道镜手术的等待时间。方法:对18头家猪进行经皮肝胆道穿刺置管术,按术后第3、5、7天随机分为3组,通过再次手术,进行瘘道扩张。观察出血量、引流管周围腹膜之间的粘连分级、光学显微镜变化。结果:经皮肝胆道穿刺置管术后第3天壁层腹膜与脏层腹膜之间已经形成粘连,粘连以Ⅱ级为主,容易被分离。第5天的粘连已完整且比较紧密。粘连以Ⅲ级为主。术后3、5 d时扩张比较容易,术后第7天瘘道开始瘢痕化,扩张比较困难。穿刺时没有发生大出血、穿刺后没有出现胆汁性腹膜炎,扩张过程中仅有少量淡红色液体。镜下见扩张后瘘道壁内表面少许裂开,未见血管壁破裂。结论:经皮肝胆道穿刺置管术后第3天或第5天进行瘘道扩张都没有发生大出血,早期进行胆道镜手术操作具有可能性。
Objective:To determine the feasibility of early dilation of post-PTCD fistulae as a strategy to shorten the waiting time for subsequent PTCS. Method: 18 pigs were operated for percutaneous transhepatic cholangiodrainage (PTCD) under general anesthesia and randomized into 3 groups (3, 5 and 7 days after PTCD). Each fistula was progressively dilated from 8F to 18F using a same method. The amount of bleeding, severity of adhesion, and microscopic histology of the fistulae were recorded. Results: At 3 days after PTCD, parietal-to-visceral adhesion of the peritonium had developed, readily to sever and mostly of Grade Ⅱ adhesions; at 5 days post-PTCD, the adhesion became complete and secure, mostly of Grade Ⅲ. Dilation was easier when performed between days 3 and 5. The fistulae began cicatrized at 7 days post-PTCD, making it difficult to be dilated. There was no massive hemorrhage or biliary peritonitis during the punctures, except for a little amount of pink fluid during dilations. Microscopically, the inner surface of fistulae showed mild disruptions, but no rupture of blood vessels was noted. Conclusion: It would be safe and reasonable to dilate the fistulae within 3 to 5 days post-PTCD.
出处
《广州医学院学报》
2005年第6期62-65,共4页
Academic Journal of Guangzhou Medical College
关键词
经皮肝胆道引流
胆道镜
猪
瘘道
percutaneous transhepatic cholangiodrainage (PTCD)
percutaneous transhepatic cholangioscopy(PTCS)
fistula
animal