Analysis Of The Reasons、Operation、the Timing Of The Re-operation Of Biliary Tract And Research Of The Triamcinolone Acetonide-chitosan Sustained-released Membrane In Vitro Release

[Objective] 1.To explore the main reasons for the re-operation of biliary tract, the main operation methods and the timing of the surgery, to sum up lessons and experiences of the biliary tract re-operation,and reduce the rate of biliary tract re-operation.2.To explore the differences for the triamcinolone acetonide sustained release membrane (TASM) in the release of different media in vitro,and explore the release behavior of TASM,so as to provide the basis of the experiment to reduce reoperation of biliary tract which is caused by bliary tract scar stricture.[Methods] 1.With retrospective analysis of the clinical data collected in the Second Affiliated Hospital of Kunming Medical University of hepatobiliary department, from 2010 January to 2015 January, which the hospitalized patients with biliary tract reoperation in 202 cases.And analysis of the main causes of biliary tract re-operation, the different operation method,and the influence on postoperative complications、the short-term outcome and long-term outcome in emergency operation and selective operation.2.Determination of the quantity of triamcinolone acetonide to release which is in TASM,in five different release mediu -physiological saline、bile、 simulated gastric juice、simulated intestinal juice and omentum majus juice、and in different release time, analysis the differences of TASM in vitro release.[Results] 1.A total of 202 patients with biliary tract re-operation, the second biliary surgery were 92.57%(187/202), the third biliary surgery were5.45%(11/202),and the fourth biliary surgery were 1.98%(4/202),there was no intraoperative death. Residual or recurrence of stones is the main reason for the second time of biliary tract surgery, the rate is 87.17%(163/187). The patients who received the Choledochotomy +T tube drainage was 47.59%(89/187), who received the Choledochotomy+Roux-en-Y Choledochojejunostomy was 37.97%(71/187), they are the main operation methods in the second biliary tract surgery,the rate is 85.56% (160/187). In the second re-operation of biliary tract, a total of 25.71%(9/35) of postoperative complications with the patients who received the Choledochotomy+T tube drainage in emergency operation,which was significantly higher than 7.41% (4/54) of those who received selective operation(X2=4.33, p<0.05); a total of 30.77%(8/26) of postoperative complications with the patients who received the Choledochotomy+Roux-en-Y Choledochojejunostomy in emergency operation,which was significantly higher than 8.89%(4/45) of those who received selective operation(X2=4.17, p<0.05). The totle of 160 patients above,from postoperation to the first time in one year to review, a total of 28.57%(10/35) of residua lcalculi with the patients who received the Choledochotomy +T tube drainage in emergency operation,which was significantly higher than 11.11%(6/54) of those who received selective operation(X2=4.39, p< 0.05); a total of 34.62%(9/26) of residua lcalculi with the patients who received the Choledochotomy+Roux-en-Y Choledochojejunostomy in emergency operation,which was significantly higher than 13.33%(6/45) of those who received selective operation(X2=4.78, p<0.05). a total of 92.74%(115/124) of postoperative good effect with the patients who received the selective operation,which was significantly higher than 83.33%(65/78) of those who received the emergency operation (X2=4.37, p<0.05).2. The percentage of total quantity of triamcinolone acetonide to release in TASM to take up of the theory of drug loadings in the five different release medium with equal variance and one-way ANOVA.analysis result manifestation,all have significant difference when both compared with each other (P<0.01),and the percentage of total quantity of TA to release in TASM to take up of the theory of drug loadings in the five different release medium,the highest proportion is in omentum majus juice,then in gastric juice、intestinal juice、bile, in turn,the lowest proportion is in physiological saline.[Conclusions] 1. Residual or recurrence of stones is the main reason for the second time of the biliary tract surgery.2. Because of the residual or recurrence of stones, the main operation methods in the second biliary tract surgery are the Choledochotomy +T tube drainage and the Choledochotomy+Roux-en-Y Choledochojejunostomy.3. The selective biliary tract re-operation could reduce postoperative complications, the rate of the postoperative calculi residual is low, and the rate of the postoperative effect is high.4. The percentage of total quantity of TA to release in TASM to take up of the theory of drug loadings in the five different release medium, the highest proportion is in omentum majus juice,then in gastric juice、intestinal juice、bile, in turn, the lowest proportion is in physiological saline.