CAJ | 학술논문

目的：探讨腹腔镜建造犬胆道梗阻模型的可行性及其与开腹方式相比的优越性。方法将16只本地健康杂种犬随机分为2组，每组8只，分别行腹腔镜或开腹胆总管结扎术，比较2组手术时间、术后并发症、术后麻醉复苏、术后胃肠道恢复情况，以及术前、术后不同时间点白细胞、C反应蛋白（C-reactive protein，CRP）及血清降钙素原（procalcitonin，PCT）水平，术后10天进行大体观粘连Nair分级并取组织行病理学观察。结果与开腹组相比，腹腔镜组手术时间短[（39．6±3.1）min vs．（69．4±8．6）min，t＝－9．183，P＝0．001]，麻醉苏醒早[（58．8±10．9）min vs．（92．4±13．9）min，t＝－5．380，P＝0．001]，术后首次自主进食早[（3．6±0．6）h vs．（6．8±1．1）h，t＝－7．439，P＝0．001]，首次排便早[（1．0±0．0）d vs．（1．9±0．6）d，t＝－3．862，P＝0．006]，各时点白细胞、CRP、粘连指数Nair评分、结扎部位胆道组织病理学分级，腹腔镜组均优于开腹组且具有统计学意义（P＜0．05），各时间点PCT、肝功能、胆红素水平2组差异无显著性（P＞0．05）。结论腹腔镜建造犬胆道梗阻模型是一种微创、简便的方式，炎症水平及腹腔粘连程度较低，有利于二次手术和进一步实验研究。
목적：탐토복강경건조견담도경조모형적가행성급기여개복방식상비적우월성。방법장16지본지건강잡충견수궤분위2조，매조8지，분별행복강경혹개복담총관결찰술，비교2조수술시간、술후병발증、술후마취복소、술후위장도회복정황，이급술전、술후불동시간점백세포、C반응단백（C-reactive protein，CRP）급혈청강개소원（procalcitonin，PCT）수평，술후10천진행대체관점련Nair분급병취조직행병이학관찰。결과여개복조상비，복강경조수술시간단[（39．6±3.1）min vs．（69．4±8．6）min，t＝－9．183，P＝0．001]，마취소성조[（58．8±10．9）min vs．（92．4±13．9）min，t＝－5．380，P＝0．001]，술후수차자주진식조[（3．6±0．6）h vs．（6．8±1．1）h，t＝－7．439，P＝0．001]，수차배편조[（1．0±0．0）d vs．（1．9±0．6）d，t＝－3．862，P＝0．006]，각시점백세포、CRP、점련지수Nair평분、결찰부위담도조직병이학분급，복강경조균우우개복조차구유통계학의의（P＜0．05），각시간점PCT、간공능、담홍소수평2조차이무현저성（P＞0．05）。결론복강경건조견담도경조모형시일충미창、간편적방식，염증수평급복강점련정도교저，유리우이차수술화진일보실험연구。
Objective To explore the feasibility of using laparoscopic technique to create animal model of biliary occlusion and its advantages as compared to laparotomy . Methods Sixteen local mongrel dogs were randomly divided into two groups with 8 dogs in each group .One group was given laparoscopic common bile duct ligation and the other group underwent laparotomy .The operation time, postoperative complications , anesthesia recovery time , gastrointestinal tract recovery condition , and the leucocyte , C-reactive protein ( CRP ) and procalcitonin ( PCT ) before and after operations were tested in different time points between the two groups.The histological features of ligation parts and the level of intraperitoneal adhesion ( Nair score) were examined 10 days after operation. Results As compared to the laparotomy group , the laparoscopy group had significant shorter operation time [(39.6 ± 3.1) min vs.(69.4 ±8.6) min, t=-9.183, P=0.001], shorter anesthesia recovery time [(58.8 ±10.9) min vs.(92.4 ± 13.9) min, t=-5.380, P=0.001], earlier first eating time [(3.6 ±0.6) h vs.(6.8 ±1.1) h, t=-7.439, P=0.001], and earlier first defecation time [(1.0 ±0.0) d vs.(1.9 ±0.6) d, t=-3.862, P=0.006].The leucocyte counts and CRP levels of different time points, adhesion index (Nair score), and histological grading of ligated bile duct in the laparoscopy group were superior to those in the laparotomy group (P<0.05).There were no significant differences in liver functions , serum PCT, and bilirubin value at different time points between the two groups (P>0.05). Conclusions Laparoscopic biliary occlusion is a simple and minimal invasive way to establish animal models . The technique is helpful to second operation and further study because of its lower inflammation rate and abdominal adhesion extent .