The Experimental Study Of Repairing Bile Duct Defect With Intraluminal Stent And The Preliminary Clinical Study

PartⅠThe experimental study of repairing bile duct defect with intraluminal stentObjective To assess the feasibility and safety of repairing bile duct defect with intraluminal stent.Methods We designed a simple bile duct stent model with medical use silicone tubes. A total of 30 Bama minipigs were randomly divided into two groups,15 pigs in each group.Two groups were formed as Group 1 with a 1.0cm segment of the common bile duct(CBD) resected and Group 2 with a 2.0cm segment of the CBD resected.Animals in both groups underwent biliary reconstruction with intraluminal stent.Both bile duct ends were bound to the stent,allowing a 1.0 cm or 2.0cm gap between them.Incidence of jaundice and bile leakage was evaluated in both groups.Five animals were sacrificed each time at 1,3,6 months postoperatively in both groups.Liver enzymes(ALT,AST, ALP) and serum total bilirubin were determined preoperatively and at 1,3,6 months. Pathomorphologic changes of the neo-bile duct and the native bile duct beside the neo-bile duct were observed by HE and Masson staining,α-SMA immunohistochemistry.Liver tissue slides with HE staining were analyzed. Cholangiography was performed for the randomly selected animals at 6 months.Results All operations were accomplished successfully.There was no postoperative jaundice in both groups.There was no bile leakage and one death(7%,1/15) because of postoperative hemorrhea caused by stress ulcer in Group 1.One animal died because of bile leakage(7%,1/15) in Group 2.There was no significant difference comparing liver enzymes(ALT,AST,ALP) and serum total bilirubin tested preoperatively with those tested in the same animal at 1 month or 3 months or 6 months postoperatively in both groups(P>0.05).The neo-bile duct with edema and congestion covered the gap between both of the CBD ends at 1 month.The scattered and irregular neo-bile duct epithelial cells were observed.Hyperplasia of collagen fiber arranged in disorder was observed.The neo-bile duct showed disappearance of edema and congestion at 3 months.The neo-bile duct epithelial cells began to form a regular mucosal monolayer. More disorderly arranged fibers were observed.The neo-bile duct resembled the native bile duct at 6 months.The neo-bile duct epithelial cells formed a flat mucosal monolayer,appearing as the native bile duct.Disorderly arranged fibers were still observed,with some orderly arranged hyperplastic fibers.Goblet cells and accessory glands were also observed at 1,3,6 months.The appearance happened in both groups. But fibers arranged much more disorderly in Group 2 than those in Group 1 at each time point.No cholestasis and infiltrating inflammatory cells were found in the liver in both groups at 1,3,6 months.The a-SMA positive expression scores showed no significant difference at 1 month comparing with those at either 3 months or 6 months in both groups(P>0.05).However,scores showed a significantly lower at 6 months than those at 3 months in both groups(P<0.05).The native bile duct showed a few accessory glands and no goblet cells under microscopy,with orderly arranged fibers forming thin layers.Cholangiography performed for the randomly selected animals at 6 months showed no bile leakage,no dilation of intrahepatic bile ducts,the CBD drainage unobstructed,and good development of the duodenum.Conclusion After the CBD resected within 2.0cm,the rest can regenerate the neo-bile duct if the bile duct blood supply well protected and repairing with free of tension.Repairing bile duct defect within 2.0cm with intraluminal stent is a safe, feasible,and easy of doing technique. PartⅡThe experimental study of delayed repairing bile duct injury with intraluminal stent and a case reportObjective To assess the feasibility and safety of delayed repairing bile duct injury with intraluminal stent.Methods A total of 5 Bama minipigs were included to establish an animal model of bile leakage.Animals underwent biliary reconstruction with intraluminal stent after 48 hours when the animal model of bile leakage established.Incidence of bile leakage was evaluated postoperatively:Liver enzymes(ALT,AST,ALP) and serum total bilirubin were determineed preoperatively and at 1 month postoperatively.Cholangiography was performed for the treated animals at 1 month.A retrospective analysis was conducted of a patient who underwent biliary reconstruction with intraluminal stent under the circumstances of acute bile duct inflammation.Results All operations were accomplished successfully.ALT,AST and serum total bilirubin tested at 1 month decreased significantly as compared with those tested preoperatively(P<0.05).There was no significant difference comparing ALP tested at 1 month with that tested preoperatively(P>0.05).There was no bile leakage after operation.Cholangiography performed for the treated animals showed no bile leakage at 1 month postoperatively.A patient under the circumstances of acute bile duct inflammation received operation for biliary tumor and underwent biliary reconstruction with intraluminal stent successfully.A remarkable alleviation of jaundice was seen in the patient postoperatively.Cholangiography performed for the patient showed no bile leakage at half a month postoperatively.Conclusion The experimental study and the preliminary clinical study show that delayed repairing bile duct injury with intraluminal stent for biliary reconstruction is a feasible and easy technique.More experimental and clinical investigations should be done.