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Repair of bile duct defect with degradable stent and autologous tissue in a porcine model

World Journal of Gastroenterology 2012年第37期18卷 5205-5210页

作者： Yue-Long Liang Yi-Chen Yu Kun Liu Wei-Jia Wang Jiang-Bo Ying Yi-Fan Wang Xiu-Jun Cai Second Department of General Surgery Sir Run Run Shaw Hospital Zhejiang Univer- sity Hangzhou 310016 Zhejiang Province China Institute of Minimally Invasive Surgery Zhejiang University Hangzhou 310016 Zhejiang Province China

AIM： To introduce and evaluate a new method to re- pair bile duct defect with a degradable stent and au- tologous tissues. METHODS： Eight Ba-Ma mini-pigs were used in this study, Experimental models with common bile duct （CBD） defect （0,5-1,0 cm segment of CBD resected） were established and then CBD was reconstructed by duct to duct anastomosis with a novel degradable stent made of poly [sebacic acid-co-（1,3-propanediol）-co- （1,2-propanediol）]. In addition, a vascularized greater omentum was placed around the stent and both ends of CBD. Cholangiography via gall bladder was per- formed for each pig at postoperative months 1 and 3 to rule out stent translocation and bile duct stricture. Complete blood count was examined pre- and post- operatively to estimate the inflammatory reaction. Liver enzymes and serum bilirubin were examined pre- and post-operatively to evaluate the liver function. Five pigs were sacrificed at month 3 to evaluate the healing of anastomosis. The other three pigs were raised for one year for long-term observation. RESULTS： All the animals underwent surgery success- fully. There was no intraoperative mortality and no bile leakage during the observation period, The white blood cell counts were only slightly increased on day 14 and month 3 postoperatively compared with that before operation, the difference was not statistically significant （P = 0.652）. The plasma level of alanine aminotrans- ferase on day 14 and month 3 postoperatively was also not significantly elevated compared with that before operation （P = 0.810）. Nevertheless, the plasma level of y-glutamyl transferase was increased after opera- tion in both groups （P = 0.004）, especially 2 wk after operation. The level of serum total bilirubin after opera- tion was not significantly elevated compared with that before operation （P = 0.227）, so did the serum direct bilirubin （P = 0.759）. By cholangiography yia gall blad- der, we found that the stent maintained its integrity of shape and was sti

关键词： degradable stent Bile duct defect Biliaryreconstruction Autologous tissue Omentum

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Changes of the colonic physiologic functions after colonic anastomosis with a degradable stent in a porcine model

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Chinese Medical Journal 2014年第18期127卷 3249-3253页

作者： Feng Xu Liang Xiao Wang Yifan He Shilin Cai Xiujun College of Medicine Zhejiang University Hangzhou Zhejiang310016 China Department of General Surgery Sir Run Run Shaw HospitalZhejiang University Institute of Minimally Invasive Surgery ofZhejiang University Key Laboratory of Laparoscopic Technique ofZhejiang Province Hangzhou Zhejiang 310016 China

Background A new procedure of colonic anastomosis with a degradable stent has already been proven to be simple, feasible, and safe in our porcine model. In this study, we evaluated its impact on the colonic physiologic functions. Methods A total of 20 pigs were assigned randomly to either a stent anastomosis group （SA, n=10） or a conventional anastomosis group （CA, n=10）. Colonic anastomosis with a degradable stent was performed in the SA group, and conventional hand-sewn anastomosis was performed in the CA group. Body weight, fecal weight, total colonic transit time, immunohistochemistry staining of interstitial cells of Cajal （ICC）, plasma diamine oxidases （DAO） levels, and Western blotting analysis of occludin were evaluated before and after anastomosis. Results No obvious diarrhea or constipation was observed in all pigs. No significant difference in body weight between the groups was detected at any time. Yet, the fecal weight was less in the CA group compared with the SA group on postoperative day （POD） 7. No observable colonic paralysis or retention occurred. For total colonic transit time, there was no significant difference between the two groups at any time or among different time points in the same group. The integrated optical density of ICC showed no significant difference on either POD 14 or 30. The plasma DAO levels were remarkably elevated after surgery, and began to decrease since POD 3. However, there was no significant difference between both two groups in plasma DAO levels at any time either. For both groups, the expression of occludin was not significantly different from their pre-surgery level on either POD 14 or 30. Conclusions According to these results, this procedure with a degradable stent was supposed to be the same as the conventional hand-sewn procedure in their impact on the colonic physiologic functions.

关键词： colonic anastomosis degradable stent physiologic function intestinal anastomosis

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