Experimental Study On Repair Of Bile Duct Injuries With ADM Grafts

Part 1:Model of common bile duct repair in Diannan small-ear pig establishedObjectives:To establish a stable and credible model of common bile duct repair in Diannan small-ear pig and lay the foundation for further experiment.Methods:70 pigs were randomly divided into seven groups,ten pigs each group. Common bile duct were removed partly and completely,and then had their common bile duct repaired by acellular dermal matrix(ADM) and ePTFE respectively.ADM group was experimental group.ADM group was divided into ADM no fistula gallbladder group and ADM fistula gallbladder group.Four groups involved ADM-partial defect-no fistula group,ADM-complete defect-no fistula group, ADM-partial defect-fistula group and ADM-complete defect-fistula group.Other three contrast groups consisted ePTFE-complete defect-no fistula group, ePTFE-partial defect-no fistula group and choledochojejunostorny group.Results:In 73 normal experiments,70 pigs survived over 2 weeks postoperation. Success rate of operation was 95.9%.Operation time of ADM group and ePTFE group were obviously shorter than choledochojejunostomy group(P＜0.05).Median survival time of ADM complicated normal gallbladder group was obviously longer than other groups(P＜0.05).Some of them are still alive 82 weeks later.Conclusion:Shorter operation time,lower complication and longer survival time all implied the effect of ADM for repairing common bile duct.We have grappled manufacture of model and supplied the base for further experiment. Part 2:Repair of Bile Duct Injuries With ADM Grafts: Experimental Study in pigsObjectives:To observe repair of common bile duct through kinds of approach, provide evidence for clinical manifestation,evaluate the experimental effect of common bile duct repair and probe into the possible mechanism.Methods:Whether complication or not were observed through serum bilirubin and MRCP at different time point.Whether breakage of micro biliary epithelial cell or not were observed through serumγ-GT.Injury of hepatic cell was observed through serum transaminase.Whether infection of biliary tract and reject reaction or not were judged through whole blood cell test.Regeneration of biliary epithelial cell,gland, vascular endothelial cell and smooth muscle were observed under light microscope and electron microscope.Regeneration of biliary epithelial cell were observed through expression of CK19.Trend of biliary stricture was observed through expression of TGFβ1.To investigate the possible repair mechanism from regeneration of biliary epithelial cell at different time point.Conclusion:White blood cell,total bilirubin,γ-GT and expression of TGFβ1 in ADM groups were lower than other groups.They were statistical significance (P＜0.05).Expression of CK19 in ADM groups was higher than other groups.There were no statistical significance between ADM-partial defect-no fistula group and ADM-complete defect-no fistula group(P＞0.05).White blood cell of ADM groups increased at second week post-operation(P＜0.05),however,was normal at other time point.Total bilirubin,γ-GT and serum transaminase of ADM groups at different time point were no statistical significance(P＞0.05).Expression of CK19 increased with time,however,expression of TGFβ1 decreased with time(P＜0.05).Regeneration of biliary epithelial cell,gland,vascular endothelial cell and smooth muscle,even nerve of ADM groups were detected under light microscope and electron microscope.No similar detection in other groups. Conclusion:Acellular dermal matrix could be used to physiologically repair bile duct defect with less complication.It is the best artificial material to date.Part 3:Repair of Bile Duct Injuries With ADM Grafts in a patientObjectives:On the basis of success of animal experiment,we have completed successfully a bile duct repair with acellular dermal matrix in a patient of iatrogenic bile duct injury.The purpose of research is to observe the effect and popularize the clinical application of the procedure.Methods:Injured bile duct was resected.Acellular dermal matrix was made into a tubular tissue with 2.5cm length and 1.0cm diameter.Both ends of ADM were anastomosed to proximal end and distant end of common bile duct respectively with 6-0 PDS.T-tube was placed into common bile duct to bolster stoma.Clinical manifestation,whole blood cell test,liver function and iconography were compared perioperatively at different time point.Results:There were no abdominal pain and fever,jaundice faded away gradually postoperation.Biliary drainage was 300ml-1000ml/d more or less.Colour of bile changed into normal by degrees.Intra peritoneal drainage was open and the colour was light bloody.Amount of drainage dropped off day after day.Whole blood cell test, serum glutamic pyruvic transaminase,serum glutamic oxalacetic transarninase,total serum protein,serum albumin and serum globulin returned to normal in first week postoperation.Serum bilirubin,serum glutamyltranspetidase and serum alkaline phosphatase declined gradually in first week postoperation.T-tube was clipped at twelfth day postoperation.T-tube Cholangiography was clear at 24^th day postoperation. Condition of the patient got well and laboratory test returned to normal at 1^st month, 3^rdmonth and 5^th month postoperation. Conclusions:No bile leakage,infection of biliary tract and reject reaction occurred.Whole blood cell test and liver function declined to normal gradually. T-tube Cholangiography displayed no biliary stricture postoperation.Operation was successful preliminary.It's possible that acellular dermal matrix is a perfect material to repair bile duct defect.