早期经皮肝胆道镜手术瘘道的实验研究

Early Dilation of PTCS Fistula in Porcine Models

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.