Zhang L, Guo S, Zhou L
Department of Plastic Surgery, Affiliated Hospital of Bengbu Medical College, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 1997 Nov;11(6):362-4.
The secondary anastomotic stenosis is often occured from the repair and reconstructive operation of the injured bile duct. It is difficult to treat and the outcome is serious. In order to prevent this complication, the fibrin glue instead of traditional suturing technique combined with inner support was used. Fifty-four hybrid dogs were divided into 3 groups. Group A received Roux-en-y choledochojejunostomy with fibrin glue; group B received Roux-en-y choledochojejunostomy, with a fibrin glue combined support left permanently in the bile duct and group C received Roux-en-y choledocholejejunostomy with fibrin glue combined a support left temporarily in the bile duct. The amount of collagen in the scar was measured at 3/4, 3, 6, 9, 12 months respectively after operation. The results showed: 1. the mature period of scar was shortened from 12 months to 9 months when fibrin glue instead of suture was used in choledochojejunostomy; 2. the mature period of scar was further shortened from 9 months to 6 months when fibrin glue combined with inner support instead of fibrin glue was used in choledochojejunostomy. The conclusions were as follows: 1. fibrin glue could facilitate the healing of wound by inhibiting the formation of scar and accelerrate the maturation of scar; 2. when the inner support was used with fibrin glue in the operation, the mature period of scar could be further shortened; 3. the mechanism of action of the fibrin glue included minimizing the injury, avoiding foreign-body reaction, modifying organization of hematoma, preventing formation of biliary fistular and enhancing intergration and cross-linkage of collagen.
继发性吻合口狭窄常发生于损伤胆管的修复重建手术。其治疗困难，后果严重。为预防这一并发症，采用纤维蛋白胶代替传统缝合技术并结合内支撑。54只杂种犬分为3组。A组行Roux-en-y胆总管空肠吻合术并使用纤维蛋白胶；B组行Roux-en-y胆总管空肠吻合术，将纤维蛋白胶联合支撑物永久性留置在胆管内；C组行Roux-en-y胆总管空肠吻合术，将纤维蛋白胶联合支撑物临时留置在胆管内。分别于术后3/4、3、6、9、12个月测量瘢痕中的胶原含量。结果显示：1. 在胆总管空肠吻合术中使用纤维蛋白胶代替缝合时，瘢痕成熟期从12个月缩短至9个月；2. 在胆总管空肠吻合术中使用纤维蛋白胶联合内支撑代替单纯纤维蛋白胶时，瘢痕成熟期从9个月进一步缩短至6个月。结论如下：1. 纤维蛋白胶可通过抑制瘢痕形成促进伤口愈合并加速瘢痕成熟；2. 手术中纤维蛋白胶与内支撑联合使用时，瘢痕成熟期可进一步缩短；3. 纤维蛋白胶的作用机制包括减少损伤、避免异物反应、改变血肿机化、预防胆瘘形成以及增强胶原的整合与交联。
