Study On Healing Of Hepatic Jejunal Anastomosis

Objective:On the basis of establishing the animal model of hepatic jejunal anastomosis,the degree of anastomosis solidity,histological characteristics,postoperative complications and the ratio of anastomotic site healing to type Ⅰ、Ⅲcollagen were studied after hepatic jejunal anastomosis.The value of hepatic jejunal anastomosis was explained systematically,which provided theoretical support for the wide application of the operation,which made the patients who could not perform biliary reconstruction benefit from the operation.Methods:Thirty-two SPF SD rats were randomly divided into 4 groups with 8 rats in each group.They were divided into preoperative group,postoperative day 1 group,postoperative 7 day group and 14 day group according to different observation time.The hepatic jejunal anastomosis was performed on the 1st day,7th day and 14th day,respectively,and the liver function was measured at the first day,the 7th day and the 14th day after operation.According to different groups,the rats were sacrificed after blood collection on the 7th day and 14th day after operation,and the bleeding,infection and leakage of anastomosis were observed in the abdominal cavity.The hepatic jejunal anastomosis of the rats in the 7th and 14th days after operation were taken,and the blasting pressure was measured respectively.The histopathological changes of hepatic jejunal anastomosis and liver were observed by HE staining.Picric acid-Sirius red staining was applied in anastomotic stoma tissues.Distribution and Characteristics of type Ⅰ and Ⅲ collagen fibers were analyzed with the Pro-plus 6.0 image processing software.Type Ⅰ and type Ⅲ collagen content,the total collagen content and type I collagen proportion of the total collagen.Results:All the experimental animals survived well at different observation time,and their appetite and activity were not abnormal.(1)Before operation,postoperative day 1,day 7 and day 14,inferior vena cava blood for liver function tests were conducted respectively,the results showed that the level of transaminase increased on the first day after operation,and no hepatic function damage occurred on day 7 and day 14 after operation.Alanine aminotransferase(ALT)and aspartate aminotransferase(AST)data for liver function were analyzed by single factor variance analysis.LSD tests were performed between the two groups(preoperative and postoperative).There were no statistical significance(P>0.05).(2)No complications such as abdominal infection,hemorrhage,anastomotic leakage,and intestinal obstruction were observed in all animals sacrificed after blood collection on the 7th and 14th days after surgery.(3)The anastomosis burst pressure was measured for the 7th day postoperative group and the 14th postoperative day group.The mean value of the burst pressure of the hepatic jejunal anastomosis was 226.88±4.61 mmHg;The mean value of the burst pressure of the hepatic jejunal anastomosis measured on the 14th day after surgery was 227.75±2.38 mmHg.The analysis of the data obtained using the independent sample test showed that there was no significant difference between the two(P>0.05).(4)HE staining:The hepatic jejunal anastomosis was observed to heal well under the microscope.The villus epithelium of intestinal mucosa was seen in the hepatic jejunal anastomosis,and the lamina propria had capillaries,small vessels and lymphatic vessels in the lamina propria.The submucosa is rich in blood vessels,lymphatics,myometrium and serosa.Intestinal smooth muscle cell,collagen,connect to hepatic lobule directly where the local bleeding and inflammatory cell infiltration may be seen,and a litttle lymphocytes,phagocytes and fibroblasts and a few granulocytes were visible locally,at the same time accompanied by capillary proliferation of collagen fibers,the formation of granulation tissue.(4)Picric acid-Sirius red staining:The total collagen content of 7th day postoperative group at hepatic jejunal anastomosis stoma was 14866.25±1871.45,and the percentage of total collagen type I collagen was 90.58±3.32%.The total collagen content of 14th day postoperative group at hepatic jejunal anastomosis stoma was 13988.38±1097.67,the percentage of the total collagen of type I collagen was 89.05±4.63%.Data using two independent samples t-test,the total collagen and type I collagen in two groups was no significant difference(P>0.05)in the proportion.Conclusion:Hepatic jejunal anastomosis had no obvious effect on liver function,had few complications and was easy to operate.The hepatic jejunal anastomosis healed well and had enough healing fastness after hepatojejunostomy.The value of hepatic jejunal anastomosis was explained systematically,which provided theoretical support for the wide application of the operation,which made the patients who could not perform biliary reconstruction benefit from the operation.