CAJ | 학술논문

目的建立胆总管探查、胃胆管引流、胆总管一期缝合的动物模型,探讨安全拔除胃胆管的时间,指导临床拔除胃胆管.方法将25条犬随机分成对照组(仅行腹腔探查,n=5)与胃胆管引流、胆总管一期缝合组(简称胃胆管组,n =20),实验组按术后3、5、7、9d经胃胆管胆道造影并拔除,随机分为4组；取吻合处胆管作苏木素-伊红(HE)染色、Masson染色、扫描电镜.结果实验组术后3、5、7、9d经胃胆管胆道造影并拔除.拔除胃胆管后,3d组2例胆漏,余实验组无1例胆漏.实验组胆管平均黏膜炎症指数:术后3d与5、7、9d比较差异有统计学意义(3.20±0.45比2.20 ±0.45、1.40±0.55、1.20±0.45,P＜0.05),术后7d比9d差异无统计学意义(P＞0.05).实验组胆管平均黏膜愈合指数:术后3d与5、7、9d比较差异有统计学意义(1.00比2.20±0.45、2.40±0.55、2.80±0.45,P＜0.05),术后5、7、9d差异无统计学意义(P＞0.05).术后5～7d,HE染色见胆管壁明显增厚；Masson染色见胆管壁大量胶原纤维增生、排列杂乱；扫描电镜见部分胆管内壁重新由上皮细胞覆盖.结论胃胆管引流术后5～7d,可安全拔除胃胆管,拔管后无1例胆漏.
목적 건립담총관탐사、위담관인류、담총관일기봉합적동물모형,탐토안전발제위담관적시간,지도림상발제위담관.방법 장25조견수궤분성대조조(부행복강탐사,n=5)여위담관인류、담총관일기봉합조(간칭위담관조,n =20),실험조안술후3、5、7、9d경위담관담도조영병발제,수궤분위4조；취문합처담관작소목소-이홍(HE)염색、Masson염색、소묘전경.결과 실험조술후3、5、7、9d경위담관담도조영병발제.발제위담관후,3d조2례담루,여실험조무1례담루.실험조담관평균점막염증지수:술후3d여5、7、9d비교차이유통계학의의(3.20±0.45비2.20 ±0.45、1.40±0.55、1.20±0.45,P＜0.05),술후7d비9d차이무통계학의의(P＞0.05).실험조담관평균점막유합지수:술후3d여5、7、9d비교차이유통계학의의(1.00비2.20±0.45、2.40±0.55、2.80±0.45,P＜0.05),술후5、7、9d차이무통계학의의(P＞0.05).술후5～7d,HE염색견담관벽명현증후；Masson염색견담관벽대량효원섬유증생、배렬잡란；소묘전경견부분담관내벽중신유상피세포복개.결론 위담관인류술후5～7d,가안전발제위담관,발관후무1례담루.
Objective To establish an animal model with installation of gastrobiliary duct drainage (GBDD) in primary suture after exploration of common bile duct,to investigate the natuaral history of the healing of bile duct and obtain the safety,appropriate time of removal of GBDD.Methods Twenty-five dogs were randomly divided into control group (n =5) and GBDD group (n =20).The GBDD group was randomly divided into four subgroups,to cholangiography,extubate,and then excised bile duct anastomoses were stained with hematoxylin and eosin (HE),Masson and Scanning electron microscope (SEM) on postoperative day (POD) 3,5,7,9 respectively.Results Two bile leakage cases were found in POD 3 group after removal of the GBDD,no bile leakage case was fund in other groups.The inflammatory cell infiltration of the bile duct anastomoses showed statistical significance among four groups on POD 3 vs 5,7,9 (3.2 ±0.45 vs 2.2 ± 0.45,1.4 ± 0.55,1.2 ± 0.45,all P ＜ 0.05).POD 7 vs 9 showed no statistically significant difference between them (P ＞ 0.05).There were significant difference in index of mucosal healing among POD 3 vs 5,7,9 (1.0 vs 2.2 ±0.45,2.4 ±0.55,2.8 ±0.45,allP ＜0.05),POD 5,7,9 showed no statistically significant difference among them (P ＞ 0.05).POD 5-7,HE staining showed that bile duct wall was thickening;Masson staining showed that the fibroblast distribution was disorderly;SEM showed that port of the bile duct restored with epithelial cell.However,the mucosa of bile duct restored poorly,chronic inflammation lasted for a long time.Conclusion It is safe to remove the GBDD on POD 5-7,there was no bile leakage.