摘要
目的用超声刀对猪胆囊管进行凝固、切割,观察有无残端胆漏的发生,进一步探讨超声刀在肝胆外科中的应用。方法将10头20kg左右的家猪分成A和B两组,A组于腹腔镜下用超声刀在Level3档3s凝固,切断胆囊管,B组用超声刀同样条件下切断胆囊管后,再在胆总管远端钳夹钛夹一道。手术中切除胆囊,观察10min,手术后3d开腹观察胆囊管残端有无胆漏发生,并取胆囊管残断组织作病理学检查。结果A组在手术中及手术后3d胆囊管残端均无胆漏发生。B组术后第3天有1例发生胆囊管残端漏。胆囊管残端组织病理学检查两组组织均炎症细胞浸润明显,管壁血管栓塞,管腔内有坏死和凝固物,但仍有腔隙存在。1例胆漏的残端组织也有炎症细胞浸润,腔内无坏死和凝固物,腔隙明显。结论超声刀对较细的胆管有切断和钳闭作用,而对粗的胆管及有胆道压力增高情况的病例有发生胆漏的可能。
Objective] To make a further discussion of the usage of harmonic scalpel in the hepatic surgery by using Harmonic scalpel to coagulate and to cut the cystic duct of pig, observing whether bile leak will take place. [Methods] 10 pigs(about 20 kg) were divided into two groups. In group A, the harmonic scalpel was used to coagulate and to cut the cystic duct (at level 3, lasting 3 seconds) under laparoscopy .In group B, after same treated as group A, a titanium clip was placed on the farend of Common Bile Duct (CBD), then the gallbladder removed. 3 days after the surgery, observing for 10 minutes, pigs were cut open to see whether bile leak happened through the stump of the cystic duct, and to make a pathologic examine of the stump tissue. [Results] There was no bile leak happened in group A both during the operation and 3 days later. Bile leak through the stump of the cystic duct was occurred after 3 days in one case, which had a titanium clip on the farend of CBD. By pathologic examination with the stump tissue of cystic duct, inflammatory cell soakage could be obviously seen, blood vessel of the duct wall embolismed. There were necrosis and coagulated tissue in the cavity of the duct, but lacuna still could be seen. Inflammatory cell soakage was also found in the case of bile leak. But no necrosis and coagulated tissue in the cavity of the duct, lacuna was manifest. [Conclusions] With harmonic scalpel, thin cystic duct can be cut and incarcerated. But if the cystic duct is thick or the pressure of the biliary tract is high, the bile leak is still probably happened.
出处
《中国内镜杂志》
CSCD
北大核心
2005年第5期449-450,453,共3页
China Journal of Endoscopy
关键词
超声刀
腹腔镜术
胆囊切除术
动物实验
胆汁渗漏
harmonic scalpel
laparoscopy
cholecystectomy
animal experiment
bile leak
