Research Of Plastic Anastomosis Combined With 5-FU In Treatment Of Benign Stricture Of Hilar Bile Duct

ObjectiveIn this study,we want to contrast the therapeutic effect of plastic anastomosis combined with 5-FU and plastic anastomosis alone.We explore the safety and feasibility of this new methed in treatment of benign stricture of hilar bile duct.MethodsThirty female miniature pigs were randomly divided into groups A,B and C.Group A and B were the control group and group C was the experimental group.Established the benign bile duct stricture model of hilar hepatis.After the formation of bile duct stricture,the bile duct of the narrow segment of group A were isolated.Group B were treated with plastic anastomosis after the separation of the stricture segment of bile duct.In group C,fluorouracil implants were placed around the anastomotic site after the plastic anastomosis.The changes of diet,mental state and urine color of all pigs were observed,and we testing the changes of routine blood and liver function after operation at 7 days,15 days,30 days,60 days and 90 days.Three months after all operations were completed,all pigs were sacrificed,and part of liver and bile duct tissue of the stenosis segment were extracted from each pig and stored for pathological examination and PCR detection.ResultsOur experiment was observed for 90 days from the day of operation.Two pigs died in the study,one died of infection in 14 days after operation,one died of liver failure in32 days postoperatively.The rest of the pigs survived to the end.The diet,mental state and urine color was no difference between postoperative and preoperative in group A,and the weight was gradually decline.In group A,each time after operation,the change of WBC was not has significant difference than preoperative(P>0.05),the RBC was lower than preoperative(P<0.05),after surgery 7 days the PLT was lower than preoperative(P<0.05),and then it gradually recovered to preoperative levels.All of the values indexes in liver function examination of group A was higher than preoperative and increased progressively(P<0.05).During 5-8 days after surgery,the diet and mental state of group B and C was gradually recovered,and the color of urine was gradually faded.By 90 days after operation,the weight of group B and C had recovered to that before the model was made.The WBC in group B and C was lower than preoperative on the 15 th day after operation(P<0.05),and then it tended to be stable.The RBC and PLT in group B and C were less than preoperative at 7 days after operation(P<0.05),and then they gradually recovered.The values of liver function examination indexes in group B and C was lower than those before operation and then it gradually decreased(P<0.05).The degree of decrease of liver function examination indexes in group C was more obvious than that in group B from 30 days after operation(P<0.05).Pathological examination showed that the inflammatory hyperplasia of bile duct epithelial cells and the thickening of bile duct wall in group C were less severe than those in group A and B.PCR results showed that the m RNA expression of TGF-β1,PDGF and CTGF in the stricture segment in group C were lower than group A and B(P<0.05).There were no significant differences in group A and B(P>0.05).Coclusion1.Plastic anastomosis combined with 5-FU was safe and feasible in the treatment of benign hilar bile duct stricture.2.Plastic anastomosis combined with 5-FU could be used to treat benign stricture of hilar bile duct and prevent the formation of anastomotic restenosis to a certain extent.3.The therapeutic effect of plastic anastomosis combined with 5-FU in the treatment of hilar benign bile duct stricture was better than that of plastic anastomosis alone.In conclusion,plastic anastomosis combined with 5-FU is safe and effective in the treatment of hilar benign bile duct stenosis,and it also plays a certain role in the prevention of postoperative anastomotic restenosis,which is worthy of our further study.