摘要
目的探讨自体腹膜管修复胆总管缺失的可行性。方法取健康雄性成年普通家兔20只,分为A、B两组,两组都建立胆总管缺损模型,切取壁层腹膜制成腹膜管,分别与胆管上、下断端行端端吻合,腹膜管外包带蒂大网膜。术后观察实验动物活动、饮食、巩膜有无黄染及二便等一般情况。A组和B组分别于修复术后4周和12周再次开腹,切取修复区胆管行HE光镜检查及免疫组化检查,观察局部组织的愈合、胆管上皮的爬行情况。结果动物存活情况:2只实验兔分别于修复术后第9 d和第15 d死亡,其余18只实验兔均健康存活至再次手术。大体标本观察:修复段胆管质地柔韧,管腔无狭窄。探查肝脏表面光滑,质韧。光镜观察:腹膜管大部分腔面覆盖着单层柱状上皮,中外层为增生纤维组织,散在淋巴细胞、浆细胞、成纤维细胞和巨噬细胞,并见较完整的毛细血管。结论自体腹膜管修复缺损胆总管后,使用带蒂大网膜包裹,腹膜管的成活率高,胆管上皮可逐渐由两端向对侧移行覆盖腹膜管腔面。
Objective To explore and discuss the feasibility of repair of bile duct defect with autologous peritoneal duct.Methods The experimental was carried out on 20 healthy male rabbits and divided them into A division and B division.Both of them set up common bile duct defect model,parietal peritoneum was cut to establish autologous peritoneal tube,then it was anastomed with the upper and lower ends of bile duct by end-to-end anastomosis respectively,peritoneal tube was wrapped by big omentum with pedicle.The changes of appetite,action,spirit,dejecta and so on were observed.Division A and B did laparotomy again after 4 weeks and 12 weeks respectively for repair operation.The tissues of liver,the pedicle peritoneal graft and common bile duct,especially the repaired segment were harvested for light microscopic examination as well as did observation with recovery of part organization and state of bile duct epithelium.Results Living state： two rabbits died in the postoperative 9th day and 15th day.The other 18 rabbits were healthy till the second operation.Observation of sample： the repaired segment could be recognized clearly,bile duct after re-pair was soft and tough,lumen was unobstructed,sliver was kept in clear and smooth as well.Inspection under light microscope： most of the inner surface of the graft was covered with epithelium.The inflammatory response lessened obviously with the cellular infiltration comprised predominantly of fibroblasts and scant of macrophages,and integrated capillary was seen.Conclusion Experimental result confirms that the survival rate of peritoneum was high for repair of bile duct defect with autologous peritoneal duct using big omental duct with pedicle to wrap,the percentage of living peritoneal tube is very high,bile duct epithelium can cover peritoneal tube from two sides to the opposite side gradually.
出处
《肝胆胰外科杂志》
CAS
2010年第5期366-370,共5页
Journal of Hepatopancreatobiliary Surgery
基金
上海市南汇区科委资助项目(NKYL0707)
关键词
肝外胆管损伤
肝外胆管缺失
修复
腹膜管
extrahepatic bile duct injury extrahepatic bile duct defect repair peritoneal duct
