The Clinical And Experimental Research Of Whether To Detain T-tube After The One-stage Prosthesis Operation Of Bile Duct Damage

Backgrounds and Aim:Bile duct damage is a serious complication of hepatobiliary surgical operation, the severe clinical results of which much attention has been paid to. Recently, with the extensive practice of Operation on biliary tract and the application and popularization of the laparoscopic cholecystectomy, the incidence rate of bile duct damage increases. According to the latest domestic documents, the laparoscopic cholecystectomy damage to bile duct is 0.3%. Although the importance of preventing bile duct dammage has been emphasized strongly, although it has become an indispensible concept in other relative clinical diagnosis work, it is still a knotty problem for the doctor of abdominal surgery on how to treat the bile duct damage that already takes place in a proper way in order to reduce the negative influence as much as possible. Topractice the one-stage prosthesis operation of bile duct damage successfully covers several aspects, such as theories, experiences, methods, technological details, etc.. This paper attempts to solve this problem through clinical analysis and animal experimentation. Methods and Results:ⅠThe Clinical Research of whether to detain T-tube or not after the one-stage prosthesis operation of bile duct damageThis paper reviews the clinical material of 27 patients in our hospital, whose extrahepatic bile duct had been constrictive after operation on biliary tract and accepted the one-stage prosthesis operation, from Sept. 2002 to Sept. 2006; 6 of them accept the end to-endanastomosis without detain T-tube to support,according to the Bismuth typing all belong toⅠ～Ⅱgroup. The writer will follow-up visit, compare and analyze several index of these patients before and after operation, such as Hepatic function,imageology,hospital day after operation, complication rate,etc..All patients has no death in ambi-operation stage. On average, these patients stayed in hospital for 8 to 10 days after operation, and were follow-up visited for 8-40 months. The rate reaches 74.07%, that is 20 people. There is no significant differe-nce in bilirubin total,aminotransferase,the inside diameter of stoma among these two groups before and after operation. In the group without detain T -tube, there was one patient with small chole-leak after operation, recovering itself through extend the abdominal cavity draining time, The rest patients were no choleplania,biliary calculus,and etc. In the group using T-tube to support, all of the T-tube were standed after 2-3 months of operation, T-tubes were drew up after 6-12 months, all patients had no choloplania,chole-leak,cholangeitis,biliary calculus,etc. The clinic control study indicate: the bile duct end to-end anastomosisis safety,the hospital day after operation and cost of hospitalization are less,avoid the abuse of T-tube detaining.ⅡThe Experimental Research of Whether to detain T-tube after the one-stage prosthesis operation of bile duct damageAccording to the patho-investigation of in recent 10 years, however, there is not any report about the whole recovery process of bile duct and the peripheral tissues after T-tube support in the bile duct damage . This experiment adopts cutting off the bile duct of babbit and a pipe supporting bile duct through carunculae major to establish a model, V.G dyeing and TGF - beta 1 immunity group dyeing on tubal wall of rabbit bile duct in different times, determine quantitatively the intensity of light TGF - beta 1 positive area and the realtioship between the integral-optical density of bile duct tissue collagen content and time, analyze the conduction of scar-hyperplasy, and at the same time observe the liver functional parameter and work out the law and characteristics of the changes of relative tissue in theory.During the whole experiment process, the leucocyte levels of all the rabbits showed no obvious differences, while bilirubin total,aminopherase shortly after operation(within one month) showed great differences between non-pipe-detaining group and pipe-detaining group, and gradually reached the same level in 2-6 months. The content of TGF - beta 1 in bile duct tissue increases according to the length of time, about 60days reaching the Max., then decreasing gradually, about 90-120 days reaching the normal standard, but there was no differences between the two groups at the same handling time. Constrasting the integral-optical density of collagen tissue,the numbers of pipe-detaining group were high than those of non-pipe-detaining group, it cue the agglutination could not be improve by pipe supporting, the excitation of an extraneous material pipe in bile duct will induce the architecture scar over-hyperplasy.Conlusion:This paper studies whether T-tube should be detained after the one-stage prosthesis operation of bile duct damage through both clinical cases and animal experimentation.The fabric-scar is the importance reason for obstruction of biliary tract and re-stricture after the bile duct damage, and that is the most difficult point in the cure of bile duct damage. It is believed traditionally that silca gel-pipe supporting the stoma is necessary for the one-stage prosthesis operation of bile duct damage, and the time should be no less than 1/2-1 year. The T-tube detaining brings negative influences to patients'living quality. Therefore, it is very meaningful for us to increase the success rate of primary repair operation, avoid T-tube detaining, or shorten the time of T-tube detaining from several aspect, such as therapy concepts, technological details, and material etc., considering the specific situations.The results from this animal experiment provide the scientific basis for choices of method of the one-stage prosthesis operation of bile duct damage,thus guide clinicians to select personalized treatment plans depending on different types of bile duct damage, in order to get the best treatment effects. This research provides the pathological changes and concrete data for the whole process after operation, and therefore help clinicians to select the most appropriate operation way for patients with bile duct damage. The writer believes it is feasible and safe not to detaining T-tube after the one-stage prosthesis operation of bile duct damage, as long as we choose indication strictly and do operations carefully. Anyway, whether T-tube will be detain, clinicians should be able to command the corresponding the indicated of operations and personalize the operation, with the principle of reducing complicationg. The ultimate aim of treatment post-injury is to keep chole-bowel access smooth, and generally speaking recover the integrity and smoothy of biliary system through the one-stage prosthesis operation of bile duct damage is the only method. As to whether to detaining T-tube after the one-stage prosthesis operation of bile duct damage and how to reduce the negative influence as much as possible, this is not only the central problem of diagnosis, but also the objective standard judging the rationality of the process and method of operation.