新型可降解镁合金胆道支架在胆总管探查术中预防狭窄的作用

发布时间：2018-04-22 03:39

本文选题：胆道支架 + 镁合金　；参考：《西安交通大学学报(医学版)》2017年05期

【摘要】：目的设计一种新型的适合应用于胆总管探查术的胆道支架,探讨其植入到动物体内的生物相容性及有效性。方法利用镁合金AZ 31B制备胆道支架。将实验犬随机分为实验组和对照组,每组6只。建立犬急性梗阻性黄疸模型,4d后胆总管直径增宽至约6mm为建模成功。实验组在胆道内放置镁合金胆道支架,并行胆总管一期缝合,对照组则单纯行应用探条扩张胆道狭窄处,并行胆道一期缝合。观察各组死亡率以及胆漏的发生率;于建模前及探查术前、术后1月、3月留取相应样本行镁离子浓度、肝功能检查;定期B超观察胆管狭窄情况;分别在探查术后1月、3月留取胆管组织标本,观察胆管的愈合情况及Masson染色观察吻合口组织胶原纤维的增生情况。结果实验组和对照组犬血液、粪便以及肝脏、心脏、脑和肺等器官中的镁离子浓度接近,实验组尿液中的镁离子浓度明显高于对照组。实验组和对照组的胆漏发生率分别为0%、16.7%,死亡率分别为16.7%、33.3%。实验组和对照组在建模前、胆总管探查术前总胆红素、碱性磷酸酶无显著性差异(P0.05),在胆总管探查术后1月、3月总胆红素、碱性磷酸酶组间比较有显著差异(P0.05)。胆总管探查术后1月和3月行B超检查提示实验组胆管通畅程度良好,无狭窄表现,而对照组胆管出现进行性狭窄,胆总管狭窄以上胆管明显扩张。实验组与对照组在胆总管探查术后1月、3月时,肉眼观察见胆管吻合口愈合良好;镜下观察实验组较对照组黏膜下胶原纤维沉积较少,新生肌纤维较多,管壁增厚较轻。结论镁合金胆道支架在体内具有良好的生物相容性,其良好的支撑及可降解性能在胆道探查手术及胆道良性狭窄的治疗中得到更好的应用。
[Abstract]:Objective to design a new type of biliary stent suitable for choledochus exploration and investigate its biocompatibility and efficacy. Methods magnesium alloy AZ 31B was used to prepare biliary stent. The dogs were randomly divided into experimental group and control group with 6 dogs in each group. A canine model of acute obstructive jaundice was established. After 4 days, the diameter of common bile duct widened to about 6mm. In the experimental group, magnesium alloy biliary stent was placed in the bile duct, and primary suture of common bile duct was performed in the control group. The mortality rate and the incidence of bile leakage were observed, the corresponding samples were collected before modeling and before exploration, 1 month after operation and 3 months after operation for magnesium ion concentration and liver function examination, and the stricture of bile duct was observed by B-ultrasound regularly. Bile duct tissue specimens were collected at 1 month and 3 months after exploratory operation to observe the healing of bile duct and the proliferation of collagen fibers in anastomotic tissue by Masson staining. Results the concentrations of mg ~ (2 +) in blood, feces, liver, heart, brain and lung of dogs in experimental group and control group were similar, and the concentration of magnesium ion in urine of experimental group was significantly higher than that of control group. The incidences of bile leakage in the experimental group and the control group were 0 and 16.70.The mortality was 16.70.33. There was no significant difference in total bilirubin and alkaline phosphatase before choledochus exploration between the experimental group and the control group (P 0.05), but there was a significant difference in total bilirubin and alkaline phosphatase between the two groups at 1 month, 3 months after choledochus exploration. One month and three months after common bile duct exploration, B-ultrasound examination showed that the bile duct in the experimental group had good patency and no stenosis, while in the control group there was progressive stenosis, and the bile duct above the common bile duct stenosis was dilated obviously. At 1 month and 3 months after choledochus exploration, the experimental group and the control group showed that the anastomosis of bile duct healed well, and the experimental group had less deposition of submucosal collagen fiber, more new muscle fibers and less thickening of the wall. Conclusion magnesium alloy biliary stent has good biocompatibility in vivo, and its good support and degradability are better used in the exploration of biliary tract and the treatment of benign biliary stricture.
【作者单位】：西安交通大学第一附属医院肝胆外科;中航工业西安医院外一科;
【基金】：陕西省科技统筹创新工程计划项目(No.2011KTCL03-21)~~
【分类号】：R657.4

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