Experimental Study Of Fibrin Sealant In Sealing Cystic Duct

Experimental study of Fibrin Sealant in sealing the Cystic Duct Objective: In this experiment, Fibrin Sealant is adopted to seal the cystic duct toexplore its efficacy and possible mechanism. And the three methods to seal the ductare compared to find the respective effect. Clinically, more than twenty operationshave been successfully carried out by this approach. This study aims to provide thesound basis for its clinical use and to introduce an easy, effective, less traumaticalternative for complicated laparoscopic cholecystectomy. Method: In the experiment, thirty-six male dogs are randomized into 4 groupswith 9 each: (A) control group; (B) experiment group 1 (to seal the cystic duct withabsorbable gelatin sponge and fibrin sealant); (C) experiment group 2 (to seal thecystic duct with fibrin sealant only); (D) experiment group 3 (to seal the Vater'sampulla of gallbladder with fibrin sealant). After the abdominal injection ofPentobarbital Sodium to anaesthetize the animals, conventional cholecystectomy iscarried out. During the operation, the anterior wall of the gallbladder is completelysectioned, leaving the posterior wall and cystic duct. The mucous membrane on theposterior wall and at opening of the cystic duct are cauterized. And then comparison ismade on the three methods to manage the cystic duct. The dogs are killed at thepost-operation day 5, 10, 15 to examine whether there are bile leakage or fistula. Andpathologic section examination is made to determine the type of local tissue and thehealing stage of the gallbladder stump. At the post-operation day 15, the retrogradecholangiography is carried out first for the animals without bile leakage. Thespecimens are taken to have Haematoxylin and Eosin( HE) staining. And comparisonis made on the incidence of post-operation bile leakage, the difference of the cysticduct healing process and sealing efficacy. Result: In the group group A and D, post-operation bile leakage happen on allthe dogs. While in the B, no post-operation bile leakage happens. In the group C, 22.2%(2/9)of the dogs have post-operation bile leakage. (1) GroupA: There is a lot ofbile in the abdomen and the stump of the gallbladder does not close. (2) Group B: 4第二军医大学硕士学位论文 英文摘要Post-operation pathologic examination shows that the cystic ducts are excellentlysealed. The HE staining reveals that at the post-operation day 5 the cystic duct isirregular with a lot of filling fibrin in it and there are many kinds of inflammatorycells too. At the post-operation day 10, the cystic duct significantly shrinks with thewalls fibrosed and the filling fibrin is absorbed. And the inflammatory cells reduce.While the regenerative fibrous connective tissue begins to form. At the post-operationday 15, the retrograde cholangiography does not reveal contrast leakage. Pathologicexamination shows that in the cystic duct there is evident granular tissue formation. (3)Group C: Bile leakage takes place in 22.2%(2/9)of the animals. (4) Group D: Thereis a lot of bile , which is similar to the situation in group A. Statistics show that there is significant difference in the incidence ofpost-operation bile leakage between group A with group Band group C. And there isno significant difference in the incidence between group A and group D. Conclusion: To seal the cystic duct with fibrin sealant combined with absorbablegelatin sponge can provide good result with local granular tissue formation. However,to the seal the duct with only fibrin sealant will lead to bile leakage and transientincompletely obstruction ofthe common bile duct in 22.2% of the cases. And to sealthe Vater's ampulla only can not effectively seal the cystic duct and results in bileleakage in all cases. In the control group, bile leakage takes place in all the animalspost-operation. So it is suggested that fibrin seala...