Kakabadze Z, Berishvili E, Długosz J W
Department of Clinical Anatomy and Operative Surgery, Georgian State Medical Academy, Tbilisi, Georgia.
Rocz Akad Med Bialymst. 2003;48:52-6.
The segmental resection of constricted bile duct and end-to-end biliary anastomosis could be an attractive alternative in the treatment of benign biliary tract stricture. The aim of this study was to restore the anatomical integrity of the hepatic-common bile duct after an artificially produced defect while maintaining the large duodenal papilla, using microsurgical technique.
The experiments were carried out on 25 mongrel dogs. The common bile duct was ligated in all of the animals during laparotomy, as a model of bile duct obstruction in humans. Relaparotomy was performed 3 days after the initial operation. The segment of bile duct, 4 cm in length was resected together with the ligature. The continuous bile flow into the duodenum was assured by a polyvinyl catheter introduced into both ends of dissected bile duct. The proximal end of the hepatic-common bile duct was fixed to a device constructed by us for the distention of the bile duct (DDBD). The anterior part of the device was exteriorized through a separate fistula and fixed to the abdominal wall. The hepatic-common bile duct distention was gradually continued during 18 days, by pulling out the mobile part of the device. After 18 days the device was removed and the distended proximal end of the hepatic-common bile duct was anastomosed end-to-end with its distal end. The sequels of this procedure were observed for up to 6 months.
The hepatic-common bile duct was distended 4 cm within 18 days. The histopathological examination has shown partial damage of the duct framework due to the distention and tension. However the patency of the duct was preserved and the recovery of normal structures were observed after the device was removed and anastomosis fashioned.
This method, developed by us, offers the possibility of restoring the integrity of injured extrahepatic bile ducts, allowing effective treatment of benign biliary strictures.
节段性切除狭窄胆管并进行胆管端端吻合术可能是治疗良性胆道狭窄的一种有吸引力的替代方法。本研究的目的是使用显微外科技术，在人为制造缺损后恢复肝总管的解剖完整性，同时保留大十二指肠乳头。
对25只杂种犬进行实验。在所有动物开腹手术期间结扎胆总管，作为人类胆管梗阻的模型。初次手术后3天再次开腹。切除4厘米长的胆管段及其结扎线。通过插入已解剖胆管两端的聚乙烯导管确保胆汁持续流入十二指肠。肝总管近端固定在我们制作的用于扩张胆管的装置（DDBD）上。该装置的前部通过一个单独的瘘口引出并固定在腹壁上。通过拉出装置的活动部分，在18天内逐渐持续扩张肝总管。18天后取出装置，将扩张的肝总管近端与远端进行端端吻合。观察该手术的后续情况长达6个月。
肝总管在18天内扩张了4厘米。组织病理学检查显示，由于扩张和张力，胆管结构有部分损伤。然而，胆管保持通畅，在取出装置并完成吻合后观察到正常结构的恢复。
我们开发的这种方法提供了恢复受损肝外胆管完整性的可能性，从而能够有效治疗良性胆道狭窄。
