Amiranashvili I, Berishvili E
Georgian State Medical Academy.
Georgian Med News. 2005 Oct(127):81-4.
The purpose of the investigation was to achieve hepaticocholedoch recovery with preserved sphincter apparatus. The experiments were carried out on 25 mongrel dogs of both sexes with body weight 12-25 kg. The animals were divided into 3 groups. The hepatocholedoch strictures were induced in the animals of group I (n=10) and II (n=10). On the 4th day following modeling the animals of group II were subjected to relaparatomy, stricture removal and hepatocholedoch distraction by means of distraction device developed by prof. Kakabadze (patent request submitted for approval). On the 18th day after the surgical procedure the animals have undergone the surgery, the distraction device was removed and the anatomical integrity of biliary tract was restored by bilio-biliary anastomosis. Performed investigations have shown that all of the animals of group I have died on the several time points after the surgery. The cause of death was cholestasis. As to animals of group II, 2 dogs have died on 24 and 35 days after the surgery because of technical shortages of the bilio-biliary anastomosis. The rest 8 experimental animals undergo surgery and postoperative period normally and they were under observation in vivarium standard conditions correspondingly. The i.v. cholangiography, performed in survived animals during postoperative period, showed compete contrast liquid flow into the duodenum. The histological test performed during distraction showed mucosal layer sclerosis. Distraction and afford made evident influence on the muscular fibers through the duct axis. Their elongation and attenuation was mentioned after 3 days from distraction. The fibroblasts local accumulation was seen. The hepaticocholedoch mucosal complete recovery was seen after apparatus was taken out and the bilio-biliary anastomosis was done. Thus, new method of hepaticocholedoch strictures surgical correction elaborated by us allows us to restore anatomical integrity of biliary tract with preserved Oddi sphincter.
本研究的目的是在保留括约肌装置的情况下实现肝外胆管的修复。实验在25只体重12 - 25千克的杂种狗身上进行，雌雄不限。动物被分为3组。在第一组（n = 10）和第二组（n = 10）的动物身上诱导形成肝外胆管狭窄。在建模后的第4天，第二组动物接受再次剖腹手术，通过卡卡卡巴泽教授研发的牵张装置（已提交专利申请待批准）切除狭窄并进行肝外胆管牵张。在手术操作后的第18天，动物再次接受手术，取出牵张装置，并通过胆管 - 胆管吻合术恢复胆道的解剖完整性。所进行的研究表明，第一组的所有动物在手术后的几个时间点死亡，死亡原因是胆汁淤积。至于第二组动物，2只狗在手术后第24天和第35天因胆管 - 胆管吻合术的技术缺陷死亡。其余8只实验动物手术及术后恢复正常，并相应地在标准饲养条件下进行观察。在存活动物术后进行的静脉胆管造影显示造影剂完全流入十二指肠。在牵张过程中进行的组织学检查显示黏膜层硬化。牵张对穿过导管轴的肌纤维产生明显影响。牵张3天后可见肌纤维伸长和变细。可见成纤维细胞局部聚集。取出装置并完成胆管 - 胆管吻合术后，肝外胆管黏膜完全恢复。因此，我们所阐述的肝外胆管狭窄手术矫正新方法使我们能够在保留奥迪括约肌的情况下恢复胆道的解剖完整性。
