Department of Surgery Department of Pathology, Ohio State University School of Medicine and Public Health, Columbus, OH, USA.
HPB (Oxford). 2011 Aug;13(8):573-8. doi: 10.1111/j.1477-2574.2011.00337.x. Epub 2011 Jun 27.
The reference standard technique for the reconstruction of the extrahepatic biliary tree is Roux-en-Y hepaticojejunostomy. This procedure is not without complications and may not be feasible in some patients. This project sought to evaluate a novel approach for repairing common bile duct injuries with a biosynthetic graft. This allows for the reconstruction of the anatomy without necessitating an intestinal bypass.
Study subjects were 11 mongrel hounds. Utilizing an open approach, the common bile duct was transected in each animal. A 1-cm graft of a synthetic bioabsorbable prosthesis was interposed over a 5-Fr pancreatic stent and sewn in place as an interposition tube graft with absorbable sutures. Intraoperative cholangiograms and monthly liver function tests were completed. Animals were killed at 6, 7, 8, 10 and 12 months.
The first five animals were killed early in the process of protocol development. One animal developed obstructive symptoms and was killed on postoperative day 14. The next five animals were longterm survivors without evidence of clinically significant graft stenosis. Mean alkaline phosphatase and total bilirubin were normal, at 140 U/l and 0.2 mg/dl, respectively. Histology showed the complete replacement of the graft with native tissue at 6 months.
Biliary reconstruction using a synthetic bioabsorbable prosthetic as an interposition tube graft is feasible based on initial results.
重建肝外胆管的参照标准技术是 Roux-en-Y 胆肠吻合术。该手术并非没有并发症，而且在某些患者中可能不可行。本项目旨在评估一种使用生物合成移植物修复胆总管损伤的新方法。这可以在不进行肠旁路的情况下重建解剖结构。
研究对象为 11 只杂种猎犬。在开放手术中，每只动物的胆总管均被横断。将 1cm 长的合成可吸收假体移植物插入 5Fr 胰管支架中，并通过可吸收缝线缝合作为间置管移植物。术中完成胆管造影和每月肝功能检查。动物在 6、7、8、10 和 12 个月时处死。
前 5 只动物在方案开发的早期阶段被处死。1 只动物出现梗阻症状，于术后第 14 天死亡。接下来的 5 只动物是长期幸存者，没有发现明显的移植物狭窄。碱性磷酸酶和总胆红素的平均值分别为 140U/L 和 0.2mg/dl，均正常。组织学显示，在 6 个月时，移植物完全被原生组织取代。
根据初步结果，使用合成生物可吸收假体作为间置管移植物进行胆道重建是可行的。
