The Experimental Study On Application Of Gastrobiliary Duct Drainage In Primary Suture After Exploration Of Common Bile Duct

Objective Establishment of animal model with installation of Gastrobiliary duct drainage (GBDD) in primary suture after exploration of common bile duct, to assess the safety and feasibility of GBDD.Methods Thirty dogs were randomly divided into three groups: control group (n=5), primary suture group (n=10) and GBDD group (n=15). The serum TBil, bile leakage case and the other complications were observed and compared.Results No case serum TBil level signifcantly increased in control group. However, 7(7/10) cases serum TBil level were signifcantly increased in primary suture group,compared with no case serum TBil level increased in GBDD group,there was signifcantly diferent(P<0.01). GBDD were all successfully withdrawn, mean (7.0±1.7) d after the operation.No bile leakage was fund in GBDD group, there was significantly different compared with 5(5/10) bile leakage cases in primary suture group (P<0.05). There were 3(3/10) cases bile peritonitis, infection of incisional wound and splitted in primary suture group. However, there was no such complications in GBDD group (all P>0.05).Conclusions GBDD is safe and feasible.It can shorten biliary drainage time and prevent occurrence of bile leakage. Therefore, it has unique value in clinical application. Objective Establishment of animal model with installation of Gastrobiliary duct drainage (GBDD) in primary suture after common bile duct exploration (CBDE), to investigate the natuaral history of the healing of bile duct and obtain the safety, appropriate time of removal GBDD.To guide clinicl practice.Methods Twenty-five dogs were randomly divided into control group (n=5) and experimental group (n=20).The experimental group was randomly divided into four grous,to cholangiography,extubate, then excised bile duct anastomoses were examined for collagen content and observed with light microscope,Scanning electron microscope (SEM) on POD 3,5,7,9 respectively.Results Two bile leakage cases were found in POD 3 group after removal of the GBDD,no bile leakage case was fund in other groups.Histological examination of the bile duct anastomoses showed statistical significance among four groups anastomoses in inflammatory cell infiltration on POD 3 vs 5,7,9(3.2±0.45 vs 2.2±0.45, 1.4±0.55, 1.2±0.45, all P<0.05).POD 7 vs 9 showed no statistically significant difference between them(P>0.05).Comprison of mucosal healing among the four groups anastomoses,there were significant difference in index of mucosal healing among POD 3 vs 5,7,9(1.0 vs 2.2±0.45,2.4±0.55,2.8±0.45,all P<0.05),POD 5,7,9 showed no statistically significant difference among them(P>0.05).There were statistical significance in terms of hydroxyproline (HP) content(mg) among the four groups and control group anastomoses, POD 3 vs 5,7,9,control group(9±1.87 vs 20.6±2.30, 22.6±2.70, 27±4.12,16. 54±2.22,all P<0.05).POD 5-7,HE staining showed that bile duct wall was thickening; Masson staining showed that bile duct wall was fibroblast proliferatingactively, distribution mixed and disorderly;SEM showed that port of the bile duct wall recovered with epithelial cell and the epithelium of mucosa membrane of bile duct restored poorly,chronic inflammation lasted for a long time.Conclusions It is safe to remove the Gastrobiliary duct drainage on POD 5-7, no bile leakage case happened.