不同结扎血管夹在兔腹腔胆囊切除术中的应用

Application of Different Type Vascular Ligating Clips on Laparoscopic Cholecystectomy in Rabbits

目的观察不同结扎血管夹在腹腔胆囊切除术后的结扎效果、炎症反应以及在体内性能稳定情况，为临床应用研究提供参考。方法将36只日本大耳白兔分成3组，即正常对照组、试验组和同类产品对照（Hem-O-lok）组，每组12只，其中试验组和同类产品对照组分别用佳助结扎血管夹和Hem-O-lok结扎夹在开腹胆囊摘除术中夹闭胆囊管及胆囊动脉。分别在术后6、12个月时处死动物，观察结扎效果及结扎部位大体病变，并取血测定谷氨酰转移酶（GGT）、肿瘤坏死因子-α（TNF-α）和肌酸激酶（CK）水平，同时取体内的结扎血管夹进行重量和特性粘度分析。结果术后试验组和同类产品对照组结扎夹均在体内结扎牢固，肝脏组织病理形态均无异常，未见出血或胆漏发生。与正常对照组比，试验组和同类产品对照组血清GGT水平在术后3d、14d以及CK水平在术后3d均明显升高（P〈0．05，P〈0．01）；此外，试验组TNF-α水平在术后3d和2个月时显著降低，同类产品对照组TNF-α水平亦在术后6个月时显著降低（P〈0．05）；但实验组血清GGT、TNF-α和CK水平与同类产品对照组比差异不显著（P〉O．05）；与原样比较，体内植入6个月、12个月后试验组结扎血管夹和同类产品对照组Hem-O-lok结扎夹的重量和粘度均无明显变化（P〉0．05）。结论佳助结扎血管夹用于夹闭胆囊管和血管结扎是有效的，在体内性能稳定，其作用效果和安全性与Hem-O-lok结扎夹类似。

Objective To provide an experimental basis for clinic application of vascular ligating clips on ligation effects, inflammation and its performance stability in vivo after cholecystectomy. Methods Thirty-six rabbits were divided into 3 groups, negative control group, experimental （Jiazhu） group and positive control （Hem-o-lok） group, 12 rabbits in each group. The gallbladder duct and gallbladder artery were closed by Jiazhu vascular ligating clips and Hem-o-lok clips in experimental group and positive control group respectively. Animals were euthanized at 6 and 12 months postoperation, the ligation effects and the gross lesion in ligation sites were observed, the serum GGT, TNF-α, CK levels and the vascular ligating clips weight as well as its intrinsic viscosity in vivo were also detected. Results The ligating clips were ligated firmly and no bleeding or bile leakage were found, and the pathological morphology of liver has also no abnormal in experimental group and positive control group. Compared with negtive control group, the serum GGT level in experimental group and Hem-o-lok group were significantly increased at 3 days and 14 days postoperation and CK level were also significantly increased at 3 days postoperation （P〈0.05, P〈0.01）. Furthermore, the TNF-α level was significantly decreased at 3 days and 2 months postoperation （P〈0.05）, and was also significantly decreased at 6 months postoperation in Hem-o-lok group （P〈0.05）. The serum GGT, TNF-α and CK levels were no significant differences between experimental group and Hem-o-lok group （P〉0.05）. Compared with original samples, the weight of ligating clips and its intrinsic viscosity in experimental group and Hem-o-lok group had no obvious changes after 6 and 12 months implanted （P〉0.05）. Conclusion It is effective for the ligation of gallblad- der duct and gallbladder artery by Jiazhu vascular ligating clips, besides, its performance is stable in vivo. The Jiazhu vascular ligating clips are similar validity and security with Hem-o-lok clips.