Analysis Of The Clinical Efficacy Of Benign Bile Duct Stricture And Properties Of The Triamcinolone Acetonide-chitosan Sustained-released Membrane

[Objective]The treatment of benign biliary stricture is a big problem in the liver and gallbladder surgery.Treatments of benign bile duct stricture include choledochojejunostomy,autologous tissue transplantation renovation,endoscopic stent implantation,Endoscopic sphincterotomy,etc.In the scar non-surgical treatment, steroid hormones have a definite therapeutic effect.The triamcinolone acetonide-chitosan sustained-released membrane is my team produced early with independent innovation.It has the following characteristics:l)The triamcinolone acetonide-chitosan sustained-released membrane inhibited expression of TGF-β1、 alpha-SMA of the fibroblasts of human benign biliary stricture in vitro.2)The triamcinolone acetonide-chitosan sustained-released membrane in the bile duct scarring have certain prevention function.Therefor,The triamcinolone acetonide-chitosan sustained-released membrane offers a new means for prevention and treatment of benign biliary stricture.This experiment has the following objective:1)From January 2010 to June 2014,78 cases of benign biliary stricture were analyzed retrospectively,discuss the causes of benign bile duct stricture and analysis the clinical curative effect of choledochojejunostomy.2)Study the physical and chemical properties of the triamcinolone acetonide-chitosan sustained-released membrane and evaluate its biological characteristics in animals,discuss its feasibility of surgical implants which is the new treatment of biliary tract scar stenosis.[Methods] Part 1:Analysis of the clinical efficacy of benign bile duct stricture.From January 2010 to June 2014,78 cases of benign biliary stricture were analyzed retrospectively,discuss the causes of benign bile duct stricture and analysis the clinical curative effect of choledochojejunostomy.Part 2:Determination of physicochemical properties. Determination of Moisture, ash content, PH value, conductivity, rotary viscometer, the heavy metal (lead), protein content, water absorption and swelling ratio test. Part 3:Evaluate its biological characteristics in animals. Evaluating its hepatotoxicity, biological histocompatibility and explore the feasibility of it as an implant for benign biliary stricture surgery,by the subcutaneous irritant reaction,biocompatibility,acute liver toxicity experiment[Conclusions] Part 1:This research through to the medical records of benign bile duct stricture and retrospective study found that:first, the cause of BBS is hepatolith, followed by iatrogenic bile duct injury.Second,hyperbilirubinemia is an independent risk factors of bilioenterostomy when it as the treatment of BBS.Third, T tube placement should follow the principle of individualization.The last,The reasonable choice of operation, remove the focus thoroughly, keep the unobstructed drainage and surgical technique is the key factors of postoperative complications when bilioenterostomy as the treatment of BBS.Part 2:Determination of physicochemical properties.The results of this study:1)Moisture and ash content of the triamcinolone acetonide-chitosan sustained-released membrane is low,to ensure the quality of membrane, which is beneficial to the store.2)PH value of it close to the human body environment, which is beneficial to use.3)The solution of the triamcinolone acetonide-chitosan sustained-released membrane is O/W microemulsion.which is beneficial to triamcinolone acetonide drug release.4)It contained heavy metal lead and protein content is extremely low, can be safely used in the human body.5)The triamcinolone acetonide-chitosan sustained-released membrane with strong hydrophilic and superior resistance to swelling,.It has stable chemical properties.Part 3:Evaluate its biological characteristics in animals. The results of this study:1)The triamcinolone acetonide-chitosan sustained-released membrane does not cause excessive inflammation.2)The triamcinolone acetonide-chitosan sustained-released membrane and hydroxypropyl chitosan have good biological histocompatibility,but the triamcinolone acetonide-chitosan sustained-released membrane has better biological histocompatibility than hydroxypropyl chitosan.The experimental results provide a theoretical basis for the future development of the triamcinolone acetonide-chitosan sustained-released membrane as an implant for BBS surgery.