Transitional Consistent Treatment Of Hilar Bile Duct Benign Stricture Of Experimental And Clinical Research

Part OneMigration consistent with a benign treatment of hilar bile duct strictureObjectiveTreatment of hilar bile duct benign stricture of a new technique to explore transitional anastomosis. Obtained hilar bile duct benign stricture transitional anastomosis theoretical basis and practical application feasibility, indications and contraindications, looking for more in line with the anatomy and physiology surgical approach through animal experiments and clinical application.Methods50miniature pigs, weighing between15-20kg, Kunming Medical College animal, room temperature, feeding, feeding solid feed, drink tap water. Miniature pigs repurchase adaptive feeding5to7days in the new environment before starting the experiment,12h, preoperative fasting and water deprivation6h, weighing, skin preparation. Were randomly divided into:A, B, C, D, E five groups. Preoperative ketamine3%pentobarbital anesthesia composite. Group A (control group) surgery: small pig supine position, fixed limbs, after disinfection to take the upper abdominal midline incision of about10cm into the abdomen. Intestine will be removed from the fully exposed the hilar carefully separated to find the bile duct from the duodenum on the edge of about5cm at the isolated section of about3cm of the bile duct, the abdomen was closed with gauze to protect. Group B surgery:open separation of bile duct with the control group, on the separation of bile duct with curved clamp forceps and electric knife electric knife touch burning curved clamp, given the physical damage of bile duct tissue, about the time about5s, or observe the clamp bile duct pale, the abdomen was closed. Group C surgery:open separation of the bile duct manufacturing narrow with group B Upon completion of the narrow manufacturing, placed in the local human the fluoride security (5-FU release formulation), the abdomen was closed. Group D operation:open the separation of bile duct manufacturing narrow with group B, the abdomen was closed, and postoperative monitoring of small-scale pig diet will be two, and liver function, bilirubin, and other indicators, to be stricture formation after anesthesia laparotomy, to find the narrow position, fully reveal the narrow bile duct to the up and down for an extended period, fully cut the stricture and removal of part of a narrow scar tissue, the two narrow ends of the normal bile duct tissue, the "Z "-type flattening shaping, valgus and migration of the suture. Group E of surgery:abdominal separation of bile duct manufacturing narrow stricture with Group D, transitional anastomosis, placed in the local human fluoride safety. Were observed after the diet, mental state and color of the urine, preoperative and postoperative one day and7days after surgery each measuring the ALT, AST, T-the BIL, the D-the BIL, all surgery completed three months after the killings, take the scar organizations and some liver tissue, and stored with liquid nitrogen until the pathological examination, and quantitative PCR analysis. Statistically using SPSS software, t-test and multivariate analysis of variance.ResultsAfter4-6h miniature pigs able to stand independent of drinking water, then gradually resume eating after7days after the urine began to turn yellow and gradually deepened.①from the preoperative to30days after a significant change (P<0.05), in addition to the control group, other groups detection of ALT, AST, T-the BIL, the D-the BIL and other indicators; and group B21days after ALT, T--BIL, D-the BIL compared with the preoperative and14days was significantly increased. Group C value slightly lower than in group B, Group D transitional anastomosis, the parameters were significantly reduced compared with Group E Group E secondary surgery in January after the index lower. The②miniature pigs were sacrificed to cut the liver and bile duct for pathological examination, the liver cells have varying degrees of injury, bile duct, part of the fiber hyperplasia in addition to the control group over time; the control group preoperative and postoperative contrast no significant changes.ConclusionsTransitional anastomosis to treat small liver hilar bile duct benign stricture is feasible and helps to reduce postoperative bile duct stenosis and stone recurrence, provided the experimental basis for clinical hilar bile duct stenosis. Part TwoTopical application Human the fluorine An Duiliang biliary stricture formation influence researchObjective:Do real-time PCR quantitative analysis of the specimens obtained from animal experiments animal experiments, to explore the effect of5-FU to inhibit scar formation and prevention of benign bile duct stricture formation。 Methods:The first part of the manufacture of benign bile duct stenosis model50miniature pigs, after execution, to take the scar tissue and stored with liquid nitrogen, the sample RNA extraction, RNA detection samples the CDNA the synthesis and electrophoresis to do real-time PCR quantitative analysis. Analysis and formation of scar tissue are closely related to TGF-betal, PDGF, of CTGF factor expression levels.Results:Experimental group, Group D (not human fluoride safety) of TGF-β1and PDGF, the expression of CTGF factor was significantly higher in group A also significantly higher than the experimental group, Group E (local place of human fluoride safety). Experimental group, Group E (local place three factor expression in human fluoride safety) higher than control group A was significantly lower than the experimental group B, and D group (not the safety of human fluoride).Conclusions:Definitely a5-FU significantly inhibited the proliferation of bile duct injury after scar, and provides a basis for further scar prevention and treatment of bile duct injury after in vivo, provided the experimental basis for clinical hilar bile duct stenosis.