微胆漏在胆管吻合口狭窄中的作用

An experimental study on the effect of minimal bile leakage on biliary Anastomotic stricture

目的观察微胆漏在胆管吻合口狭窄病理过程中的作用。方法将斑马猪24头随机分成3组。假手术组（S组），模拟吻合在胆管扎孔2圈，每圈8孔。对照组（c组），游离胆管20mm，切除约5mm，行端端吻合，T型管引流。治疗组（T组），依C组方式手术，在吻合口以远置Forley导尿管（8号）至吻合口上15mm引流胆汁，气囊注水阻断胆汁流经吻合口。分析各组微胆漏、术部瘢痕增生、吻合口内径及与其近端胆管内径比值。结果S组与C组处理部位均有瘢痕增生，管壁厚度分别为（1．5±0．2）、（1．6±0．3）mm，但差异无统计学意义（P〉0．05）。T组管壁厚度为（0．9±0．2）mm，与前两组比较差异均有统计学意义（P〈0．05）；T组微胆漏明显少于S组及c组，3组引流液胆红素含量分别为（36．8±5．4）、（141．9±17．7）、（107．5±11．6）μmol／L，T组较S组及C组差异均有统计学意义（P〈0．05）。结论吻合口微胆漏是吻合口瘢痕增生狭窄的重要原因之一，设法消除胆汁刺激可以改善吻合口瘢痕增生。

Objective To explore the effect of minimal bile leakage on pathologic procedure of biliary anastomotic stricture. Methods ：24 experimental Bama mini-pigs were randomly divided into three groups. The sham operation group （ group S）, we stabbed （ not actually anastomosed） the bile duct two circles by anastomotic needle after dissecting the bile duct. The control group （ group C）, we excised the bile duct 5mm in length after dissecting the bile duct and treated by end-to-end anastomosis. The treatment group （group T） ,we treated in the same way as the group C and drained the bile by inserting a Forley urethral catheter （NO. 8） in the bile duct above the anastomotic stoma 15 mm,then infused water into the air chamber （the amount was determined by the diameter of the bile duct） to block the bile flow passing the anastomotic stoma. Then we analyzed the degree of hyperplasia in each group and the ratio of the diameter of the anastomotic stoma to the bile duct above. Results There were anastomotic stoma hyperplasia and decrease in diameter in group S and group C, the lenghth of the wall of the bile duct was （ 1.5±0.2 ） mm and （ 1.6 ±0.3 ） mm, but when compared each other the resuh was not statistically significant （ P 〉 0.05 ）. Hyperplasia also existed in group T, the lenghth of the wall of the bile duct was （ 0.9 ± 0.2 ） mm, when compared with S and C the results were statistically significant （ P 〈 0.05 ）. The SB of the drainage of group T,group,S and group C was （36.8± 5.4） , （ 141.9 ±17.7）, （ 107.5 ±11.6）μmol/L, when compared with S and C the results were statistically significant （ P 〈 0.01 ）. Conclusion The minimal bile leakage of the anastomotic stoma plays an important role in biliary anastomotie stoma stricture. If measures can be taken to prevent the chronic stimulation of minimal bile leakage, the stricture formation will be inhibited obviously.