Huang Qiang, Liuz Chen-Hai, Zhu Cheng-Lin, Xiez Fang, Hu San-Yuan
Hepatogastroenterology. 2013 Nov-Dec;60(128):1865-72.
BACKGROUND/AIMS: The surgical time of obstructive bile duct injury when biliary-enteric reconstruction is needed remains controversial till now.
Sixty dogs models of bile duct injury were established and divided into six groups according to the days (0, 5, 10, 15, 20, 30 days) of injury. At the time of surgery, biopsy was taken and Roux-en-Y hepaticojejunostomy was performed. The morphology and local histopathology of bile duct, the liver function in different periods were observed. Surgical complications and survival were also evaluated.
In the early time (5-10 days), the proximal bile ducts dilated continuously and showed acute inflammation change, but slow in the later period (10-30 days). Moreover, the bile duct wall gradually transformed into fibroplasias from the inflammatory edema after 10 days. During the development of jaundice, the liver function was damaged, especially after 20 days. After reconstructing, the bile leakages in the groups that repaired within 10 days were more than the ones in other groups (7 vs. 3, p < 0.05), and the malnutrition or organ failure occurring in 3 months was most at the 30-day group (n = 7, p < 0.05).
The period between 10 and 20 days after bile duct obstruction may be optimal for surgical repair.
背景/目的：对于需要进行胆肠重建时梗阻性胆管损伤的手术时机，至今仍存在争议。
建立60只胆管损伤犬模型，并根据损伤后的天数（0、5、10、15、20、30天）分为六组。手术时取活检并进行Roux-en-Y肝空肠吻合术。观察胆管的形态和局部组织病理学、不同时期的肝功能。评估手术并发症和生存率。
早期（5 - 10天），近端胆管持续扩张并呈现急性炎症改变，但后期（10 - 30天）变化缓慢。此外，10天后胆管壁从炎性水肿逐渐转变为纤维组织增生。在黄疸发展过程中，肝功能受损，尤其是20天后。重建后，10天内修复的组胆汁漏比其他组更多（7例对3例，p < 0.05），30天组3个月内发生营养不良或器官衰竭的情况最多（n = 7，p < 0.05）。
胆管梗阻后10至20天可能是手术修复的最佳时期。
