经皮经胆囊犬胆总管金属支架置入的可行性研究

Percutaneous transcholecystic biliary metal stent implantation:feasible study in the canine

目的探讨经皮经胆囊犬胆总管金属支架置入动物模型的安全性和可行性。方法成年健康家犬10条,禁食24小时后全麻,行CT扫描定位胆囊,超声引导下于定位点穿刺胆囊,行胆囊及肝外胆管造影。应用引导装置及硬导丝将5F鞘及自制支架释放装置送入胆总管内,经皮经胆囊管将金属支架置入胆总管内。术后定期检测肝功,术后即刻及术后1个月行上腹部CT检查。结果在10条狗中,胆囊穿刺成功率为100%。胆总管金属支架置入成功率为80%(8条),两条狗由于胆囊管与胆总管成角锐利,支架置入失败。放置支架的实验动物中,7条狗术后状态良好,1条狗于术后24小时死于胆汁漏。在1个月的观察期内,肝功正常的实验动物为4条,两只狗的碱性磷酸酶在术后5和10天升高,一条狗的总胆红素升高。在观察期内CT扫描各实验动物支架均未出现明显移位。结论本研究成功建立了以犬为试验动物的经皮经胆囊途径胆管介入的动物模型。实验证明该动物模型安全、可行,且适合于长期的试验研究。

Objective The purpose of this study was to report our initial experiment with a canine model for biliary metal stent implantation through a percutaneous transcholecystic access. Methods Ten dogs, weighing 22.5-29.5 kg, fasted for 24 h then anesthesia. After computer tomography guidance, the canines＇ gallbladders were punctured percutaneously under ultrasound. Omnipaque was given to opacity the gallbladder and extrahepatic biliary system. Using a introducer set and superstiff wire, a 5F sheath was placed through the cystic duct into the common bile duct. Then mental stents were deployed into the common bile duct through cystic duct with the delivering device. Follow-up one month with CT scan and chemistry test. Autopsy was performed after one month to evaluate the safety and feasibility of this animal model. Results Puncture of gallbladder was successful in all ten dogs and advancing the sheath through the small cystic ducts proved to be the most challenging procedure. Metallic stents were successfully deployed into eight dogs, while the other two were failure because of the sharp angulation of cystic duct and common bile duct. Seven animals tolerated the whole procedures （including deploying the metal stent） without changes in their clinical conditions and no symptoms. One died of bile leakage. Conclusion This technique allows a safe and feasible access into the biliary system using a percutaneous transcholecystic approach especially for a long-term interventional research.