Sutureless choledochoduodenostomy with an intraluminal degradable stent in dog model

作     者：ZHU Ling-hua LIANG Xiao LIN Hui WANG Yi-fan ZHU Yi-ping CAI Xiu-jun 

作者机构：Department of General Surgery Sir Run Run Shaw HospitalCollege of Medicine the Institute of Minimally Invasive SurgeryZhejiang University Hangzhou Zhejiang 310016 China 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2011年第124卷第13期

页      面：1999-2003页

核心收录：

学科分类：10[医学] 

基　　金：This study was supported by grants from the National Natural Science Foundation of China (No. 30772132), the Natural Science Foundation of Zhejiang Province (No. Y206154, No.Y208511) and the Hi-tech Research and Development Program of China (863 Program No. 2007AA02Z446) 

主　　题：stent surgical anastomosis duodenum common bile duct 

摘      要：Background It is difficult and time-consuming for carrying out conventional hand-sewn bilioenteric anastomosis, especially for small bile duct anastomosis and laparoscopic procedure. In order to simplify it, we have developed a novel procedure of sutureless bilioenteric anastomosis with an intraluminal degradable stent. This study aimed to evaluate the feasibility and safety of this technique with cholangioduodenostomy in dog model. Methods A patent intraluminal degradable stent tube for sutureless choledochoduodenostomy in dog model was made with polylactic acid in diameter of 3 mm or 4 mm. Thirty-eight dogs were randomly divided into to a stent group （SG, n=20） and a control group （CG, n=18）. Dogs in the SG underwent sutureless choledochoduodenostomy with intraluminal stent, while the CG underwent conventional choledochoduodenostomy （single layer discontinuous anastomosis with absorbable suture）. Dogs of each group were divided into 4 subgroups according to time of death （1,3, 6, and 12 months postoperatively） to evaluate the healing of anastomosis. Operation time, intraoperative tolerance pressure of anastomosis, rate of postoperative bile leakage, bursting pressure of anastomosis were compared between the two groups. Anastomosis tissue was observed afterwards by pathology evaluation, hydroxyproline content, serum bilirubin, liver enzyme level and magnetic resonance cholangio-pancreatography （MRCP） to assess the stricture. Results All procedures were completed successfully. The surgical time of the SG was significantly less than the CG （SG： （19.2±4.3） minutes, vs. CG： （29.2±7.1） minutes, P=0.000）. One bile leakage was occurred in either group. No significant difference of intraoperative tolerance pressure of anastomosis, rate of bile leakage and postoperative bursting pressure of anastomosis, anastomotic stricture, hydroxyproline content, serum bilirubin and liver enzyme level was found between the two groups. MRCP showed no anastomosis stricture and obstruction