Application Of Stress And Complaisance Distention Of Extrahepatic Bile Ducts In Reconstruction Of Biliary Tract Injury In Dogs

Objective:To investigate the influence of magnitude and endurance of local biliary ducts pressure to local bile duct wall in dogs, and to explore suitable and safe initial stress for local biliary tract distention.Method: An inlaid bile duct dilator(IBDD) was divised and made by ourselves, andthe relationship of pressure, affusion volume and diameter of its expanded ballbladder was tested in vitro. Twenty mongrel dogs were randomly divided into five groups. Group A was sham operation and only placed IBDD as biliary drainage in common bile duct; In group B and C, IBDD were placed in common bile duct as biliary drainage and dilated it through affusing 0.1ml and 0.2ml volume of water (the pressure of expanded ballbladder are 0.24Kpa and 0.58Kpa respectively) to dilate expandable ballbladder for ten minutes respectively before vacuating the expanded ballbladder; In group D and E, IBDD were placeded in common bile duct as biliary drainage and dilated it through affusing 0.1ml and 0.2ml volume of water respectively, and water of expanded ballbladder in two groups were not vacuated during all experimental period. Each group was underwent repeat laparotomy after postoperative day 7. Serum total bilirubin(TB), alanine aminotransferase(ALT), aspartate aminotransferase;aspartate transaminase(AST), bile duct diameter(BDD), and histologic changes of biliary duct wall and hepatic tissue were observed during bilarypredilation and postdilation of each group.Result: Compared with group A, BDD of postdilation was expanded in groupD , ALT and AST of serum were highly increased in group E. There is no significant difference in histologic changes of biliary duct wall between group A and B; mucous hyperemia and hydropsia of biliary duct accompanied with part mucous exfoliation in group C; In group D the bile duct diameter widened and the thick of biliary wall thickened, and these changes were also observed in adjacent biliary duct; part biliary duct wall necrosised and adhered to epiploon and duodenum in group E.Conclusion: The magnitude of local biliary ducts pressure for the influence oflocal bile duct wall is related to persistent time. Normal local biliary ducts wall can bear pressure in some extent and can not cause complaisance distention or pathologic changes. Suitable pressure of biliary ducts and lengthening persistent time cause local bile duct complaisance distention. Unsuitable pressure of biliary ducts will cause part mucous exfoliation of local biliary ducts. With persistent time lengthening, unsuitable pressure of biliary ducts will cause whole layer mucous exfoliation of local biliary ducts or whole layer damaged. The suitable and safe initial stress for extrahepatic biliary tract distention in dogs is 0.24Kpa.Part two: Constructing wide caliber of local biliary tract to supply earlier period cholangiojejunostomy reconstruction ofbile duct injury in dogsObjective: To study the morphological characteristic of wide caliber of localbiliary tract constructed by increasing internal pressure of local bile duct and the feasibility to supply earlier period reconstruction of bile duct injury in dogs.Method: Twelve mongrel dogs were randomly divided into two groups. Group A was only placed inlaid bile duct dilator(IBDD) as biliary drainage in common bile duct; In group B , IBDD were placed in common bile duct as biliary drainage and dilated it through afrusing 0.1 ml, 0.15 ml, 0.2 ml, 0.25ml volume of water (the...