带蒂空肠瓣修补胆管缺损的实验研究

The experimental study of pedicled jejunum flap repaired bile duct defect

目的研究用带蒂空肠瓣修补实验犬局部缺损的胆总管，了解术后空肠瓣及胆管局部的病理变化及术后胆汁的pH值变化。方法将实验犬的胆总管部分切除，胆总管局部形成缺损，用带蒂空肠瓣修补胆管缺损。术中、术后测定胆汁的pH值，术后第6个月取活检行病理检查。结果实验犬术后生存6个月，此期间实验犬的生命体征无异常，体重增加。实验犬术前与术后第一天胆汁的pH值差异有统计学意义（P〈0．01）。术后第一天引起胆汁的pH值增大。术前与术后第6个月胆汁的pH值的差异无统计学意义（P〉0．5）。术后病理显示：吻合口愈合良好，胆管上皮的黏膜细胞与空肠黏膜上皮细胞排列整齐（10／10）；但空肠瓣粘膜萎缩，胆管粘膜增生，有大量淋巴细胞、浆细胞及少量中性粒细胞浸润，未见多核巨细胞（10／10），淋巴细胞、浆细胞浸润（10／10），淋巴滤泡形成（3／10）。结论用小面积的带蒂空肠瓣修补缺损的胆总管，能达到临床上的一期愈合。在术后6个月用于修补的空肠瓣能适应胆管局部的微环境，并保持胆汁pH值稳定。带蒂空肠瓣能用于胆管狭窄的修复手术。

Objective To study the physiologic and pathlogic alteration of the artificial bile duct generated by pedicled jejunum flap（CBD）in repairing local defect common bile duct of dog. Methods Common bile duct defected model was generated by partially cutting off CBD of dog. The pedicled je- junum flap with mesentery blood supply was created to repair the local defect CBD. The pH of bile was measurated during and post-operation, the pathologic study was undertaken after 6 months. Results The experimental group live 6 months and the symptom and signs is abnormal after opera- tion. The result of blood routine and biochemistry examination is no change（P〈0.05）. The pH of postoperative bile decrease（P〈0.01）. The pH of bile was changed remarkably 1 day after the pedi- cled jejunum flap replacement. But no significant changing in the following 6 months（P〈0.05）. The postoperative pathologic study show： the anastomosis of experimental group healing well, and fiber tissue proliferates at the site of anastomosis, The Epithelium of the jejunum flap was atrophy and there were large quantity of lymphocytes, plasma cells and neutrophil within the jejunum flap（10/10）. The epithelium of bile duct nearby the jejunum flap appears slight proliferate and infused with lymphocytes and plasma cells（10/10）. There were lymphoid follicles in a/10 cases. Conclusions The jejunum flap repairing bile duct healing well, but there was inflamatic change around the jejunum flap and nearby bile duct after the replacement. These observation suggested it is feasible to use the jejunum flap repai ring the defected bile duct. The local physiology is stable without any changes in pH of bile acid. The alterative materials like umbilical ligment, blood vessel would be favorable in repair of defected bile duct.