[1]高苏平,马大喜,韩　江,等.带蒂胃浆肌瓣管修复猪胆总管缺损的实验研究[J].新乡医学院学报,2019,36(10):912-916.[doi:10.7683/xxyxyxb.2019.10.003]
　GAO Su-ping,MA Da-xi,HAN Jiang,et al.Experimental study on repairing common bile duct defect with pedicled gastric sarcomuscular flap of pig[J].Journal of Xinxiang Medical University,2019,36(10):912-916.[doi:10.7683/xxyxyxb.2019.10.003]
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带蒂胃浆肌瓣管修复猪胆总管缺损的实验研究
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
36
期数:
2019年10
页码:
912-916
栏目:
基础研究
出版日期:
2019-10-05

文章信息/Info

Title:
Experimental study on repairing common bile duct defect with pedicled gastric sarcomuscular flap of pig
作者:
高苏平1; 马大喜1; 韩　江1; 蔡　端2
（1.上海市健康医学院附属周浦医院普通外科，上海　201318；2.复旦大学附属华山医院普外科，上海　200040）
Author(s):
GAO Su-ping1; MA Da-xi1; HAN Jiang1; CAI Duan2
（1.Department of General Surgery，Zhoupu Hospital Affiliated to Shanghai University of Medicine ＆ Health Sciences，Shanghai 201318,China；2.Department of General Surgery,Huashan Hospital Affiliated to Fudan University,Shanghai 200040,China）
关键词:
肝外胆管损伤; 肝外胆管缺损; 修复; 带蒂胃浆肌瓣管
Keywords:
extrahepatic bile duct injury;  extrahepatic bile duct defect;  repair;  pedicled gastric seromuscular flap tube
分类号:
R575
DOI:
10.7683/xxyxyxb.2019.10.003
文献标志码:
A
摘要:
目的　探讨带蒂胃浆肌瓣管修复胆总管缺损的基础和临床应用可行性。方法　取雄性成年猪18头，随机分为带蒂胃浆肌瓣管组、胆总管断端吻合组和胆肠内引流组，每组6头。切取猪0.5～0.8 cm胆总管制备胆总管缺损模型。带蒂胃浆肌瓣管组猪以带血管蒂胃壁浆肌瓣分别与胆总管上、下断端吻合；胆总管断端吻合组猪胆总管两断端直接吻合；胆肠内引流组猪行胆总管空肠Rox-en-Y吻合。于术前及术后4、12周抽取3组猪耳静脉血检测肝功能；术后12周每组猪行安乐死，迅速开腹，切取修复区胆总管行苏木精-伊红染色及免疫组织化学检查，观察局部组织的愈合及胆总管上皮的爬行情况。观察胆总管断端吻合组和胆肠内引流组吻合口有无狭窄。结果　3组猪均存活。带蒂胃浆肌瓣管组猪术后大体检查显示肝脏呈紫红色，光滑，质地柔软，胆总管修复段质地较柔软，管壁平整，管腔光滑通畅。胆总管断端吻合组和胆肠内引流组猪吻合口均无明显狭窄。带蒂胃浆肌瓣管组猪术后肝脏组织切片显示肝脏间质内少量散在粒细胞呈轻度炎症反应，胆肠内引流组猪术后肝脏组织切片见肝脏间质内大量粒细胞聚集呈明显炎症反应。术后12周，带蒂胃浆肌瓣管组猪胃浆肌瓣管腔面完整覆盖着单层柱状上皮，中外层为增生肌纤维、纤维组织，可见散在淋巴细胞、浆细胞、成纤维细胞和巨噬细胞，并见较完整的毛细血管；胆总管断端吻合组猪胆总管黏膜下可见大量成纤维细胞，并部分纤维化；胆肠内引流组猪吻合口亦可见上皮增生，局部纤维化。胆道上皮免疫指标细胞角蛋白7呈阳性表达，钙网膜蛋白呈阴性表达。3组猪术后4、12周总胆红素（TBIL）、丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）水平与术前比较差异无统计学意义（P>0.05）。3组猪术后4、12周TBIL、ALT、AST水平比较差异均无统计学意义（P>0.05）。结论　带蒂胃浆肌瓣管修复猪胆总管缺损，胆总管上皮可逐渐由两端向中央移行覆盖修复段管腔面。
Abstract:
Objective　To explore the basic and clinical feasibility of pedicled gastric sarcomuscular flap in the repair of common bile duct defect.Methods　Totally 18 male adult pigs were randomly divided into pedicled gastric pulp muscle flap tube group，bile duct anastomosis group and bile bowel drainage group，with six pigs in each group.Bile duct defect model was established by resecting 0.5-0.8 cm segment of common bile duct （CBD）.In the pedicled gastric pulp muscle flap tube group，the CBD was reconstructed by upper and lower ends anastomosis with pedicled gastric seromuscular flap tube respectively.In the bile duct anastomosis group，two broken bile duct ends were directly anastomosed.The choledochal jejunum Rox-en-Y anastomosis was performed in the choledochal drainage group.Ear venous blood samples were taken from the three groups of pigs before operation and at 4,12 weeks after surgery to detected the liver function.The experimental pigs of each group were euthanized at 12 weeks after the operation，and the healing of local tissues and the crawling of bile duct epithelium were observed by Hematoxylin-eosin staining (HE) and immunohistochemical examination.Stenosis of anastomosis in the bile duct anastomosis group and the intrabile drainage group was observed.Results　All the pigs in the 3 groups survived.Liver color purple-red，smooth，soft texture was seen in pigs of the pedicled gastric pulp muscle flap tube group.The repair section of CBD was soft with smooth wall and smooth cavity.There was not stenosis of the anastomosis in the bile duct anastomasis group and the bile bowel drainage group.Postoperative liver tissue section showed that，there was a small amount of scattered granulocytes in the liver stroma in the pedicled gastric pulp muscle flap tube group which indicated a mild inflammatory response;and there was a large number of granulocytes in the liver stroma in the bile bowel drainage group which indicated obvious inflammatory response.At twelve weeks after surgery, the lumen surface of the pedicled sarcoplasmic muscle flap in the pigs in the pedicled gastric pulp muscle flap tube group was completely covered with single columnar epithelium, and the middle and outer layers were proliferated muscle fibers and fibrous tissues, with scattered lymphocytes, plasma cells, fibroblasts and macrophages, and relatively complete capillaries.In the bile duct anastomosis group, there were a large number of fibroblasts and some fibrosis under the mucosa of the choledochal.In the bile bowel drainage group，epithelial hyperplasia and local fibrosis of anastomotic stoma could be found.The immune indexes of bile duct epithelium were positive with cell keratin 7 expression and negative with Calretinin expression.Compared with that before operation,there was no significant difference in the total bilirubin（TBIL），alanine aminotransferase(ALT) and aspartate aminotransferase（AST） levels at 4,12 weeks afterthe operation among the three groups (P>0.05).There was no significant difference in the TBIL，ALT and AST levels among the three groups at 4 and 12 weeks after the operation (P>0.05). Conclusion　Repairing bile duct defect with pedicled gastric seromuscular flap tube can maintain lumen patency and vitality,the bile duct epithelium can gradually from both ends to the contralateral transitional cover surface of cavity.

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更新日期/Last Update: 2019-10-05