本文選題：膽道支架 + 鎂合金�。� 參考：《西安交通大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2017年05期

【摘要】：目的設(shè)計(jì)一種新型的適合應(yīng)用于膽總管探查術(shù)的膽道支架,探討其植入到動(dòng)物體內(nèi)的生物相容性及有效性。方法利用鎂合金AZ 31B制備膽道支架。將實(shí)驗(yàn)犬隨機(jī)分為實(shí)驗(yàn)組和對(duì)照組,每組6只。建立犬急性梗阻性黃疸模型,4d后膽總管直徑增寬至約6mm為建模成功。實(shí)驗(yàn)組在膽道內(nèi)放置鎂合金膽道支架,并行膽總管一期縫合,對(duì)照組則單純行應(yīng)用探條擴(kuò)張膽道狹窄處,并行膽道一期縫合。觀察各組死亡率以及膽漏的發(fā)生率;于建模前及探查術(shù)前、術(shù)后1月、3月留取相應(yīng)樣本行鎂離子濃度、肝功能檢查;定期B超觀察膽管狹窄情況;分別在探查術(shù)后1月、3月留取膽管組織標(biāo)本,觀察膽管的愈合情況及Masson染色觀察吻合口組織膠原纖維的增生情況。結(jié)果實(shí)驗(yàn)組和對(duì)照組犬血液、糞便以及肝臟、心臟、腦和肺等器官中的鎂離子濃度接近,實(shí)驗(yàn)組尿液中的鎂離子濃度明顯高于對(duì)照組。實(shí)驗(yàn)組和對(duì)照組的膽漏發(fā)生率分別為0%、16.7%,死亡率分別為16.7%、33.3%。實(shí)驗(yàn)組和對(duì)照組在建模前、膽總管探查術(shù)前總膽紅素、堿性磷酸酶無(wú)顯著性差異(P0.05),在膽總管探查術(shù)后1月、3月總膽紅素、堿性磷酸酶組間比較有顯著差異(P0.05)。膽總管探查術(shù)后1月和3月行B超檢查提示實(shí)驗(yàn)組膽管通暢程度良好,無(wú)狹窄表現(xiàn),而對(duì)照組膽管出現(xiàn)進(jìn)行性狹窄,膽總管狹窄以上膽管明顯擴(kuò)張。實(shí)驗(yàn)組與對(duì)照組在膽總管探查術(shù)后1月、3月時(shí),肉眼觀察見(jiàn)膽管吻合口愈合良好;鏡下觀察實(shí)驗(yàn)組較對(duì)照組黏膜下膠原纖維沉積較少,新生肌纖維較多,管壁增厚較輕。結(jié)論鎂合金膽道支架在體內(nèi)具有良好的生物相容性,其良好的支撐及可降解性能在膽道探查手術(shù)及膽道良性狹窄的治療中得到更好的應(yīng)用。
[Abstract]:Objective to design a new type of biliary stent suitable for choledochus exploration and investigate its biocompatibility and efficacy. Methods magnesium alloy AZ 31B was used to prepare biliary stent. The dogs were randomly divided into experimental group and control group with 6 dogs in each group. A canine model of acute obstructive jaundice was established. After 4 days, the diameter of common bile duct widened to about 6mm. In the experimental group, magnesium alloy biliary stent was placed in the bile duct, and primary suture of common bile duct was performed in the control group. The mortality rate and the incidence of bile leakage were observed, the corresponding samples were collected before modeling and before exploration, 1 month after operation and 3 months after operation for magnesium ion concentration and liver function examination, and the stricture of bile duct was observed by B-ultrasound regularly. Bile duct tissue specimens were collected at 1 month and 3 months after exploratory operation to observe the healing of bile duct and the proliferation of collagen fibers in anastomotic tissue by Masson staining. Results the concentrations of mg ~ (2 +) in blood, feces, liver, heart, brain and lung of dogs in experimental group and control group were similar, and the concentration of magnesium ion in urine of experimental group was significantly higher than that of control group. The incidences of bile leakage in the experimental group and the control group were 0 and 16.70.The mortality was 16.70.33. There was no significant difference in total bilirubin and alkaline phosphatase before choledochus exploration between the experimental group and the control group (P 0.05), but there was a significant difference in total bilirubin and alkaline phosphatase between the two groups at 1 month, 3 months after choledochus exploration. One month and three months after common bile duct exploration, B-ultrasound examination showed that the bile duct in the experimental group had good patency and no stenosis, while in the control group there was progressive stenosis, and the bile duct above the common bile duct stenosis was dilated obviously. At 1 month and 3 months after choledochus exploration, the experimental group and the control group showed that the anastomosis of bile duct healed well, and the experimental group had less deposition of submucosal collagen fiber, more new muscle fibers and less thickening of the wall. Conclusion magnesium alloy biliary stent has good biocompatibility in vivo, and its good support and degradability are better used in the exploration of biliary tract and the treatment of benign biliary stricture.
【作者單位】： 西安交通大學(xué)第一附屬醫(yī)院肝膽外科;中航工業(yè)西安醫(yī)院外一科;
【基金】：陜西省科技統(tǒng)籌創(chuàng)新工程計(jì)劃項(xiàng)目(No.2011KTCL03-21)~~
【分類(lèi)號(hào)】：R657.4

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