生物粘合剂预防胆道损伤修复重建术后吻合口再狭窄

USE OF FIBRIN GLUE IN THE PREVENTION OF SECONDARY ANASTOMOTIC STENOSIS FROM REPAIR AND RECONSTRUCTION OF THE INJURY OF THE BILE DUCT

传统丝线缝合技术修复重建胆道易形成吻合口瘢痕性狭窄，导致梗阻性黄疸和胆汁性肝硬化。为了克服丝线缝合组织加重瘢痕形成的缺点，应用生物粘合剂（ＦＧ）替代缝线结合内支撑导管建立各种胆肠吻合口瘢痕动物实验模型，定期对吻合口瘢痕组织进行生化胶原测定，从瘢痕形成的角度观察胆肠吻合口愈合过程，明确ＦＧ可促进伤口愈合、减少瘢痕形成和加速瘢痕成熟软化；内支撑保留６个月，瘢痕成熟，从而为预防胆道狭窄提供了有效措施。

The secondary anastomotic stenosis is often occured from the repair and reconstructive operation of the injured bile duct. It is difficult to treat and the outcome is serious. In order to prevent this complication, the fibrin glue instead of traditional suturing technique combined with inner support was used. Fifty four hybrid dogs were divided into 3 groups. Group A received Roux en y choledochojejunostomy with fibrin glue; group B received Roux-en-y choledochojejunostomy, with a fibrin glue combined support left permanently in the bile duct and group C received Roux en y choledocholejejunostomy with fibrin glue combined a support left temporarily in the bile duct. The amount of collagen in the scar was measured at 3/4, 3, 6, 9, 12 months respectively after operation. The results showed: ① the mature period of scar was shortened from 12 months to 9 months when fibrin glue instead of suture was used in choledochojejunostomy; ② the mature period of scar was further shortened from 9 months to 6 months when fibrin glue combined with inner support instead of fibrin glue was used in choledochojejunostomy. The conclusions were as follows: ① fibrin glue could facilitate the healing of wound by inhibiting the formation of scar and accelerrate the maturation of scar; ② when the inner support was used with fibrin glue in the operation, the mature period of scar could be further shortened; ③ the mechanism of action of the fibrin glue included minimizing the injury, avoiding foreign body reaction, modifying organization of hematoma, preventing formation of biliary fistular and enhancing intergration and cross linkage of collagen.