脱细胞真皮基质修复胆管缺损的实验研究
|
摘要
第一部分猪胆道缺损修补实验动物模型的建立
目的:建立稳定可靠的滇南小耳猪胆道缺损修补模型,为进一步的实验奠定基础。
方法:实验动物随机分7组,每组各10只猪。于胆囊管汇入处以下约1cm的胆总管造部分缺损与整段离断缺损,分别以脱细胞真皮基质、膨体聚四氟乙烯及胆肠吻合术修复,脱细胞真皮基质修复为实验组,同时实验组又分为胆囊造瘘与不造瘘组,共4组,即脱细胞真皮基质部分缺损不造瘘组,脱细胞真皮基质整段缺损不造瘘组,脱细胞真皮基质部分缺损造瘘组,脱细胞真皮基质整段缺损造瘘组,膨体聚四氟乙烯(共2组,膨体聚四氟乙烯整段缺损不造瘘组与膨体聚四氟乙烯部分缺损不造瘘组)及胆肠吻合术(1组)修复为对照组。
结果:73次正式实验中,70例术后存活超过2周,手术成功率95.9%。脱细胞真皮基质组和膨体聚四氟乙烯组手术时间明显短于胆肠吻合组(P＜0.05);脱细胞真皮基质不造瘘组中位生存期明显高于其他各组(P＜0.05),82W以后仍有存活。
结论:较短的手术时间,较低的手术后并发症,较长的存活时间均提示脱细胞真皮基质不造瘘组修复胆道缺损效果最佳。同时我们掌握了该模型的制作方法,为下一步的实验提供了基础。
第二部分脱细胞真皮基质修复猪胆管缺损的实验研究
目的:通过各种技术手段观察研究各组术后胆管修复情况,为其临床表现提供证据,评价脱细胞真皮基质修复猪胆管缺损的实验效果,初步探讨其可能机制
方法:不同时间点血清胆红素、磁共振胆道成像(MRCP)观察有无胆道狭窄等胆道并发症出现。血清γ-谷氨酰转肽酶以判断有无微胆道上皮的破坏,血转氨酶以判断肝细胞破坏情况,不同时间点血常规及病理检查以判断有无胆道感染及排斥反应发生,光镜、电镜观察有无胆道上皮、腺体、血管、平滑肌等再生及再生情况,免疫组化CK19测定以判断胆道上皮再生的情况,免疫组化TGF-β_1的测定判断有无胆道狭窄的趋势。并通过不同时间点各项检测情况,初步判断其可能的修复机制。
结果:脱细胞真皮基质不造瘘修复组在白细胞计数、总胆红素、γ-谷氨酰转肽酶、TGF-β_1表达均低于其他各组(P＜0.05),CK19表达均高于其他各组(P＜0.05),脱细胞真皮基质部分缺损不造瘘组与脱细胞真皮基质整段缺损不造瘘组两组之间无统计学差异(P＞0.05),脱细胞真皮不造瘘组在术后2周白细胞总数升高(P＜0.05),其余术后时间点正常,脱细胞真皮不造瘘组总胆红素、γ-谷氨酰转肽酶、转氨酶值各时间点无统计学差异(P＞0.05),CK19表达随时间增加而升高(P＜0.05),TGF-β_1表达随时间增加而降低(P＜0.05);脱细胞真皮基质修复组光镜、电镜观察有胆道上皮、腺体、血管、平滑肌等再生,甚至神经的再生,余组无类似发现。
结论:脱细胞真皮基质可能生理性修复胆道并重建其功能,并发症少,是目前为止效果最好的生物人工材料。
第三部分脱细胞真皮基质修复人整段胆管缺损
目的:在动物实验成功的基础上,我们用脱细胞真皮基质对一例整段缺损的医源性胆道损伤病人予以修复,观察修复效果,探讨最终临床应用推广可能。
方法:手术切除损伤段胆管及其周围共约2.5cm长胆管,将脱细胞真皮基质制作成长约2.5cm、直径约1.0cm的管状组织,上下分别用6-0 PDS线连续对端吻合胆管切缘,置8号T管于吻合口支撑,对比手术前后不同时间点的临床表现、血常规、肝功及影像学变化。
结果:术后无上腹部绞痛、高热,黄疸逐渐减退,每日引流胆汁300ml-1000ml不等,由淡黄色混浊、内有胆泥过渡到金黄色清亮的正常胆汁,腹腔引流通畅,引流液为淡红色,量从最初的200ml迅速过渡到10ml,血常规、血清谷丙转氨酶、谷草转氨酶、总蛋白、白蛋白、球蛋白等1周内均恢复正常,血清总胆红素、直接胆红素、间接胆红素、谷氨酰转肽酶、碱性磷酸酶逐渐下降,术后12d夹闭T管,术后24d T管造影提示左、右肝管及胆总管下端通畅,无狭窄。术后一月、三月、五月无腹痛、黄疸、发热,复查血常规、血清谷丙转氨酶、谷草转氨酶、总蛋白、白蛋白、球蛋白正常,总胆红素、直接胆红素、间接胆红素、谷氨酰转肽酶、碱性磷酸酶逐渐下降至正常。
结论:无胆漏、胆道感染、排异反应发生,血常规、肝功能正常,T管造影无胆道狭窄;手术初步成功。脱细胞真皮基质可能是人理想的整段胆道缺损修复材料。
Part 1:Model of common bile duct repair in Diannan small-ear pig established
Objectives:To establish a stable and credible model of common bile duct repair in Diannan small-ear pig and lay the foundation for further experiment.
Methods:70 pigs were randomly divided into seven groups,ten pigs each group. Common bile duct were removed partly and completely,and then had their common bile duct repaired by acellular dermal matrix(ADM) and ePTFE respectively.ADM group was experimental group.ADM group was divided into ADM no fistula gallbladder group and ADM fistula gallbladder group.Four groups involved ADM-partial defect-no fistula group,ADM-complete defect-no fistula group, ADM-partial defect-fistula group and ADM-complete defect-fistula group.Other three contrast groups consisted ePTFE-complete defect-no fistula group, ePTFE-partial defect-no fistula group and choledochojejunostorny group.
Results:In 73 normal experiments,70 pigs survived over 2 weeks postoperation. Success rate of operation was 95.9%.Operation time of ADM group and ePTFE group were obviously shorter than choledochojejunostomy group(P＜0.05).Median survival time of ADM complicated normal gallbladder group was obviously longer than other groups(P＜0.05).Some of them are still alive 82 weeks later.
Conclusion:Shorter operation time,lower complication and longer survival time all implied the effect of ADM for repairing common bile duct.We have grappled manufacture of model and supplied the base for further experiment.
Part 2:Repair of Bile Duct Injuries With ADM Grafts: Experimental Study in pigs
Objectives:To observe repair of common bile duct through kinds of approach, provide evidence for clinical manifestation,evaluate the experimental effect of common bile duct repair and probe into the possible mechanism.
Methods:Whether complication or not were observed through serum bilirubin and MRCP at different time point.Whether breakage of micro biliary epithelial cell or not were observed through serumγ-GT.Injury of hepatic cell was observed through serum transaminase.Whether infection of biliary tract and reject reaction or not were judged through whole blood cell test.Regeneration of biliary epithelial cell,gland, vascular endothelial cell and smooth muscle were observed under light microscope and electron microscope.Regeneration of biliary epithelial cell were observed through expression of CK19.Trend of biliary stricture was observed through expression of TGFβ1.To investigate the possible repair mechanism from regeneration of biliary epithelial cell at different time point.
Conclusion:White blood cell,total bilirubin,γ-GT and expression of TGFβ1 in ADM groups were lower than other groups.They were statistical significance (P＜0.05).Expression of CK19 in ADM groups was higher than other groups.There were no statistical significance between ADM-partial defect-no fistula group and ADM-complete defect-no fistula group(P＞0.05).White blood cell of ADM groups increased at second week post-operation(P＜0.05),however,was normal at other time point.Total bilirubin,γ-GT and serum transaminase of ADM groups at different time point were no statistical significance(P＞0.05).Expression of CK19 increased with time,however,expression of TGFβ1 decreased with time(P＜0.05).Regeneration of biliary epithelial cell,gland,vascular endothelial cell and smooth muscle,even nerve of ADM groups were detected under light microscope and electron microscope.No similar detection in other groups.
Conclusion:Acellular dermal matrix could be used to physiologically repair bile duct defect with less complication.It is the best artificial material to date.
Part 3:Repair of Bile Duct Injuries With ADM Grafts in a patient
Objectives:On the basis of success of animal experiment,we have completed successfully a bile duct repair with acellular dermal matrix in a patient of iatrogenic bile duct injury.The purpose of research is to observe the effect and popularize the clinical application of the procedure.
Methods:Injured bile duct was resected.Acellular dermal matrix was made into a tubular tissue with 2.5cm length and 1.0cm diameter.Both ends of ADM were anastomosed to proximal end and distant end of common bile duct respectively with 6-0 PDS.T-tube was placed into common bile duct to bolster stoma.Clinical manifestation,whole blood cell test,liver function and iconography were compared perioperatively at different time point.
Results:There were no abdominal pain and fever,jaundice faded away gradually postoperation.Biliary drainage was 300ml-1000ml/d more or less.Colour of bile changed into normal by degrees.Intra peritoneal drainage was open and the colour was light bloody.Amount of drainage dropped off day after day.Whole blood cell test, serum glutamic pyruvic transaminase,serum glutamic oxalacetic transarninase,total serum protein,serum albumin and serum globulin returned to normal in first week postoperation.Serum bilirubin,serum glutamyltranspetidase and serum alkaline phosphatase declined gradually in first week postoperation.T-tube was clipped at twelfth day postoperation.T-tube Cholangiography was clear at 24~(th) day postoperation. Condition of the patient got well and laboratory test returned to normal at 1~(st) month, 3~(rd)month and 5~(th) month postoperation.
Conclusions:No bile leakage,infection of biliary tract and reject reaction occurred.Whole blood cell test and liver function declined to normal gradually. T-tube Cholangiography displayed no biliary stricture postoperation.Operation was successful preliminary.It's possible that acellular dermal matrix is a perfect material to repair bile duct defect.
目的:建立稳定可靠的滇南小耳猪胆道缺损修补模型,为进一步的实验奠定基础。
方法:实验动物随机分7组,每组各10只猪。于胆囊管汇入处以下约1cm的胆总管造部分缺损与整段离断缺损,分别以脱细胞真皮基质、膨体聚四氟乙烯及胆肠吻合术修复,脱细胞真皮基质修复为实验组,同时实验组又分为胆囊造瘘与不造瘘组,共4组,即脱细胞真皮基质部分缺损不造瘘组,脱细胞真皮基质整段缺损不造瘘组,脱细胞真皮基质部分缺损造瘘组,脱细胞真皮基质整段缺损造瘘组,膨体聚四氟乙烯(共2组,膨体聚四氟乙烯整段缺损不造瘘组与膨体聚四氟乙烯部分缺损不造瘘组)及胆肠吻合术(1组)修复为对照组。
结果:73次正式实验中,70例术后存活超过2周,手术成功率95.9%。脱细胞真皮基质组和膨体聚四氟乙烯组手术时间明显短于胆肠吻合组(P＜0.05);脱细胞真皮基质不造瘘组中位生存期明显高于其他各组(P＜0.05),82W以后仍有存活。
结论:较短的手术时间,较低的手术后并发症,较长的存活时间均提示脱细胞真皮基质不造瘘组修复胆道缺损效果最佳。同时我们掌握了该模型的制作方法,为下一步的实验提供了基础。
第二部分脱细胞真皮基质修复猪胆管缺损的实验研究
目的:通过各种技术手段观察研究各组术后胆管修复情况,为其临床表现提供证据,评价脱细胞真皮基质修复猪胆管缺损的实验效果,初步探讨其可能机制
方法:不同时间点血清胆红素、磁共振胆道成像(MRCP)观察有无胆道狭窄等胆道并发症出现。血清γ-谷氨酰转肽酶以判断有无微胆道上皮的破坏,血转氨酶以判断肝细胞破坏情况,不同时间点血常规及病理检查以判断有无胆道感染及排斥反应发生,光镜、电镜观察有无胆道上皮、腺体、血管、平滑肌等再生及再生情况,免疫组化CK19测定以判断胆道上皮再生的情况,免疫组化TGF-β_1的测定判断有无胆道狭窄的趋势。并通过不同时间点各项检测情况,初步判断其可能的修复机制。
结果:脱细胞真皮基质不造瘘修复组在白细胞计数、总胆红素、γ-谷氨酰转肽酶、TGF-β_1表达均低于其他各组(P＜0.05),CK19表达均高于其他各组(P＜0.05),脱细胞真皮基质部分缺损不造瘘组与脱细胞真皮基质整段缺损不造瘘组两组之间无统计学差异(P＞0.05),脱细胞真皮不造瘘组在术后2周白细胞总数升高(P＜0.05),其余术后时间点正常,脱细胞真皮不造瘘组总胆红素、γ-谷氨酰转肽酶、转氨酶值各时间点无统计学差异(P＞0.05),CK19表达随时间增加而升高(P＜0.05),TGF-β_1表达随时间增加而降低(P＜0.05);脱细胞真皮基质修复组光镜、电镜观察有胆道上皮、腺体、血管、平滑肌等再生,甚至神经的再生,余组无类似发现。
结论:脱细胞真皮基质可能生理性修复胆道并重建其功能,并发症少,是目前为止效果最好的生物人工材料。
第三部分脱细胞真皮基质修复人整段胆管缺损
目的:在动物实验成功的基础上,我们用脱细胞真皮基质对一例整段缺损的医源性胆道损伤病人予以修复,观察修复效果,探讨最终临床应用推广可能。
方法:手术切除损伤段胆管及其周围共约2.5cm长胆管,将脱细胞真皮基质制作成长约2.5cm、直径约1.0cm的管状组织,上下分别用6-0 PDS线连续对端吻合胆管切缘,置8号T管于吻合口支撑,对比手术前后不同时间点的临床表现、血常规、肝功及影像学变化。
结果:术后无上腹部绞痛、高热,黄疸逐渐减退,每日引流胆汁300ml-1000ml不等,由淡黄色混浊、内有胆泥过渡到金黄色清亮的正常胆汁,腹腔引流通畅,引流液为淡红色,量从最初的200ml迅速过渡到10ml,血常规、血清谷丙转氨酶、谷草转氨酶、总蛋白、白蛋白、球蛋白等1周内均恢复正常,血清总胆红素、直接胆红素、间接胆红素、谷氨酰转肽酶、碱性磷酸酶逐渐下降,术后12d夹闭T管,术后24d T管造影提示左、右肝管及胆总管下端通畅,无狭窄。术后一月、三月、五月无腹痛、黄疸、发热,复查血常规、血清谷丙转氨酶、谷草转氨酶、总蛋白、白蛋白、球蛋白正常,总胆红素、直接胆红素、间接胆红素、谷氨酰转肽酶、碱性磷酸酶逐渐下降至正常。
结论:无胆漏、胆道感染、排异反应发生,血常规、肝功能正常,T管造影无胆道狭窄;手术初步成功。脱细胞真皮基质可能是人理想的整段胆道缺损修复材料。
Part 1:Model of common bile duct repair in Diannan small-ear pig established
Objectives:To establish a stable and credible model of common bile duct repair in Diannan small-ear pig and lay the foundation for further experiment.
Methods:70 pigs were randomly divided into seven groups,ten pigs each group. Common bile duct were removed partly and completely,and then had their common bile duct repaired by acellular dermal matrix(ADM) and ePTFE respectively.ADM group was experimental group.ADM group was divided into ADM no fistula gallbladder group and ADM fistula gallbladder group.Four groups involved ADM-partial defect-no fistula group,ADM-complete defect-no fistula group, ADM-partial defect-fistula group and ADM-complete defect-fistula group.Other three contrast groups consisted ePTFE-complete defect-no fistula group, ePTFE-partial defect-no fistula group and choledochojejunostorny group.
Results:In 73 normal experiments,70 pigs survived over 2 weeks postoperation. Success rate of operation was 95.9%.Operation time of ADM group and ePTFE group were obviously shorter than choledochojejunostomy group(P＜0.05).Median survival time of ADM complicated normal gallbladder group was obviously longer than other groups(P＜0.05).Some of them are still alive 82 weeks later.
Conclusion:Shorter operation time,lower complication and longer survival time all implied the effect of ADM for repairing common bile duct.We have grappled manufacture of model and supplied the base for further experiment.
Part 2:Repair of Bile Duct Injuries With ADM Grafts: Experimental Study in pigs
Objectives:To observe repair of common bile duct through kinds of approach, provide evidence for clinical manifestation,evaluate the experimental effect of common bile duct repair and probe into the possible mechanism.
Methods:Whether complication or not were observed through serum bilirubin and MRCP at different time point.Whether breakage of micro biliary epithelial cell or not were observed through serumγ-GT.Injury of hepatic cell was observed through serum transaminase.Whether infection of biliary tract and reject reaction or not were judged through whole blood cell test.Regeneration of biliary epithelial cell,gland, vascular endothelial cell and smooth muscle were observed under light microscope and electron microscope.Regeneration of biliary epithelial cell were observed through expression of CK19.Trend of biliary stricture was observed through expression of TGFβ1.To investigate the possible repair mechanism from regeneration of biliary epithelial cell at different time point.
Conclusion:White blood cell,total bilirubin,γ-GT and expression of TGFβ1 in ADM groups were lower than other groups.They were statistical significance (P＜0.05).Expression of CK19 in ADM groups was higher than other groups.There were no statistical significance between ADM-partial defect-no fistula group and ADM-complete defect-no fistula group(P＞0.05).White blood cell of ADM groups increased at second week post-operation(P＜0.05),however,was normal at other time point.Total bilirubin,γ-GT and serum transaminase of ADM groups at different time point were no statistical significance(P＞0.05).Expression of CK19 increased with time,however,expression of TGFβ1 decreased with time(P＜0.05).Regeneration of biliary epithelial cell,gland,vascular endothelial cell and smooth muscle,even nerve of ADM groups were detected under light microscope and electron microscope.No similar detection in other groups.
Conclusion:Acellular dermal matrix could be used to physiologically repair bile duct defect with less complication.It is the best artificial material to date.
Part 3:Repair of Bile Duct Injuries With ADM Grafts in a patient
Objectives:On the basis of success of animal experiment,we have completed successfully a bile duct repair with acellular dermal matrix in a patient of iatrogenic bile duct injury.The purpose of research is to observe the effect and popularize the clinical application of the procedure.
Methods:Injured bile duct was resected.Acellular dermal matrix was made into a tubular tissue with 2.5cm length and 1.0cm diameter.Both ends of ADM were anastomosed to proximal end and distant end of common bile duct respectively with 6-0 PDS.T-tube was placed into common bile duct to bolster stoma.Clinical manifestation,whole blood cell test,liver function and iconography were compared perioperatively at different time point.
Results:There were no abdominal pain and fever,jaundice faded away gradually postoperation.Biliary drainage was 300ml-1000ml/d more or less.Colour of bile changed into normal by degrees.Intra peritoneal drainage was open and the colour was light bloody.Amount of drainage dropped off day after day.Whole blood cell test, serum glutamic pyruvic transaminase,serum glutamic oxalacetic transarninase,total serum protein,serum albumin and serum globulin returned to normal in first week postoperation.Serum bilirubin,serum glutamyltranspetidase and serum alkaline phosphatase declined gradually in first week postoperation.T-tube was clipped at twelfth day postoperation.T-tube Cholangiography was clear at 24~(th) day postoperation. Condition of the patient got well and laboratory test returned to normal at 1~(st) month, 3~(rd)month and 5~(th) month postoperation.
Conclusions:No bile leakage,infection of biliary tract and reject reaction occurred.Whole blood cell test and liver function declined to normal gradually. T-tube Cholangiography displayed no biliary stricture postoperation.Operation was successful preliminary.It's possible that acellular dermal matrix is a perfect material to repair bile duct defect.
引文
[1]Boutelier P.Complications of Laparoscopic Cholecystectomy:Evaluation Study[J]Bull Acad Natl Med,1998,18:617-626
[2]黄志强.医源性胆道损伤:老问题.新意义[J].中国实用外科杂志,1999,(8):451.
[3]李海民,高志清.医源性胆管损伤再手术原因分析及防治[J].中华肝胆外科杂志,2002,8(6):340
[4]Takatsuki M,Yanaga K,Okudaira S,et al.Duct-to-duct biliary reconstruction in adult-to-adult living donor liver transplantation[J].Clinical Transplantation,2002,16:345-349
[5]刘有生,解兴俊,丁春辉等.带血管蒂胃壁修复肝外胆管缺损12例报告[J].中国实用外科杂志,1997,17(11):644
[6]刘建明,马利林,施公胜.壁层腹膜修复胆管缺损模型组织中转化生长因子β_1的表达[J]南通医学院学报,2004,24(4):392-394
[7]刘亚光,张文福,牛力春等.带蒂胆囊瓣转移修补肝外胆管壁缺损[J].西北国防医药杂志,2000,12(4):285-286
[8]李振水,李春林,赵延玲等.带蒂空肠瓣移植修复肝外胆管缺损九例报告[J].齐鲁肿瘤杂志,1999,6:124-125
[9]Comez NA,Alvarez LR,Mite A,et al.Repair of bileduct injuries with Gore-Tex vas -cular grafts:experimental study in dogs[J]Gastrointest Surg,2002,6(1):116
[10]任为,时德.胆管修复与重建材料的研究及其临床应用[J],中国普通外科杂志,20022(11):109-110
[11]窦春青,周宁新.组织工程化人工胆管材料学研究进展[J].解放军医学杂志,2007,3(32):672-673
[12]Livesey SA,Herndon DN,Hollyoak MA,et al.Transplanted acellular allograft dermal matrix.Potential as a template for the reconstruction of viable dermis[J].Transplantation,1995,60:1-9.
[13]Wainwright DJ.Use of an acellular allografe dermal matrix(ALLoDerm) in the management of full-thickness burns[J].Burns,1995,21:243-248.
[14]刘流,梁德江,袁申鹏飞等.脱细胞膀胱细胞外基质作为膀胱替代材料的实验研究[J].中华实验外科杂志,1999,16(2):181-182
[15]李健,李志强,杨汉林.脱细胞异体真皮基质口腔组织补片在颌面外科的应用[J].医学临床研究,2004,9(21):1070
[16]杨晓平,卜建国,蔡秀军.腹腔镜胆囊切除术的手术时间对机体应激反应的影响[J].中国微创外科杂志,2007,9(7):914
[17]Terblanche J,Allison HF,Northover JM.An ischemia basis for biliary strictures[J ].Surgery,1988,94:52-57
[1]Tocchi A,Mazzoni G,Liotta G,et al.Late development of bile duct cancer in patient s who had biliary-enteric drainage for benign disease:a follow-up study of more than 1,000 patients.Ann Surg,2001,234(1):210-214
[2]Ruka M,Rowmski WA,Lipski M,et al.Expanded polytetrafluoroethylene grafts m restoring bile drainage in dogs.Z Exp Chir Transplant Kunstliche Organe,1987,20(6):317-323
[3]G(?)mez NA,Alvarez LR,Mite A,et al.Repair of bile duct injuries with Gore-Tex vascular grafts:experimental study in dogs.J Gastrointest Surg,2002,6(1):116=120
[4]Nakashima S,Nakamura T,Miyagawa K,et al.In situ tissue engineerm8 of the bile duct using polypropylene mesh-collagen tubes.Int J Artif Organs,2007,30(1):75-85
[5]Miyazawa M,Torii T,Toshimitsu Y,et al.A tissue=engineered artificial bile duct grown to resemble the native bile duct.Am J Transplant,2005,5(6):1541-1547
[6]Rosen M,Ponsky J,Petras R,et al.Small intestinal submucosa as a bioscaffold for biliary tract regeneration.Surgery,2002,132(3):480-486
[7]osen M,Ponsky J,Petras R,et al.Novel bile duct repair for bleeding biliary anastomatic varices:case report and literature review.J Gastrointest Surg,2005,9(2):832
[8]Livesey SA,Hemdon DN,Hollyoak MA,et al.Transplanted acellular allograft dermal matrix. Potential as a template for the reconstruction of viable dermis[J].Transplantation,1995,60:1-9.
[9]Wainwright DJ.Use of an acellular allografe dermal matrix(ALLo-Derm) in the management of full-thickness burns[J].Bums,1995,21:243-248
[10]林健,郝金瑞,金杰等。人同种异体真皮脱细胞真皮基质在尿道重建中的临床应用。中华医学杂志,2005,85(15):1057-1059
[11]刘流,梁德江,申鹏飞等.组织工程学材料替代输尿管缺损的动物实验及临床应用.中华泌尿外科杂志,1999,20(10):604-607
[12]傅小兵,王德文,主编.创伤修复基础[M].第1版.北京:人民军医出版社,1997.12
[13]Wahl SM.The role of transforming growth facto r-beta in inflammatory p rocesses[J].Imm unol Res,1991,10:249
[14]Border WA,Noble NA.Transforming growth factorβin tissue fibrosis.N Eng J Med,1994,10:1286-1292.
[15]任为,时德膨体聚四氟乙烯补片修复胆管缺损的实验研究.中国修复重建外科杂志,2001 15(5):305-307
[1]Jason K,Melissa S,et al.Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy perioperative results in 200 Patients.Annals of Surgery,2005, 241(5):786-795
[2]Bismuth H,Majno PE.Biliary strictures:classification based on the principles of surgical treatment.World J Surg,2001,25(10):1241-1244
[3]刘海峰。胆肠吻合术的重新评估。肝胆胰外科杂志,2006,18(4):264-265
[4]Tocchi A,Mazzoni G,Liotta G,et al.Late development of bile duct cancer in patients who had biliary-enteric drainage for benign disease:a follow-up study of more than 1,000 patients.Ann Surg,2001,234(2):210-214.
[5]马颂章,李训虎,李次会等。用于腹壁缺损修复的新材料—脱细胞后的组织基质材料。外科理论与实践,2005,10(2):188-189
[6]林健,郝金瑞,金杰等。人同种异体真皮脱细胞基质在尿道重建中的临床应用。中华医学杂志,2005,85(15):1057-1059
[7]张伟,胡敏,王恩博等。脱细胞异体真皮基质修复口腔黏膜缺损的临床研究。中华口腔医学杂志,2005,40(3):241-243
[1]何振平,别平,柳凤轩 胆管狭窄替代性组织修复的再认识.肝胆胰外科杂志,2003,16(1):16-18
[2]夏亮芳.医源性胆管损伤的预防和治疗[J].普外临床,1993,(8)4:201.
[3]Belzer FO,Mck Watts J,Rossi RL.Auto-reconstruction of the common bile duct after venous patch graft.Ann Surg,1965,162(3):346-355
[4]夏盛城,严仁俊.小切口胆囊切除术282例胆管损伤的预防[J].南通医学院学报,1988,18(1):118.
[5]Halpern Z,Rubin M,Harach G,et al.Bile and plasma lipid composi-tion in non-obese normo-lipidemic subjects with and without eholesterolgallstones[J].Liver,1993,13(5):246-252.
[6]Krahenbuhl L,Selaras G,Wente WN,et al.Incidence,risk factors,andprevention of biliary tract injurie during laparoscopic cholecysistectomy in suitzerland[J].World J Surg,2001,29(100):1325-1328.
[7]Tocehi A,Mazzoni G,Liotta G,et al.Late development of bile duet cancer in patient s who had biliary-enteric drainage for benign disease:a follow-up study of more t hart 1,000 patients.Ann Surg,2001,234:210-214.
[8]黄志强.空肠吻合方式与抗返流设计.见:黄志强胆道外科学[M].济南:山东科学技术出版社,1998.736.
[9]VILA JJ,LLUNAJ,SALAT,et al.Hepatoporto-appendieostomy.Our experience in 3 cases of biliary cystic disease[J].CirPediatr,1997,10(2):82-85.
[10]Delarue A,Chappuis J P,Esposito C,et al.Is the appendix graft suitable for routine biliary surgery in children ?[J].J Pediatr Surg,2000,35(9):1312-1316.
[11]刘会春,张培新,崔培元,等.自体静脉段移植修复胆管缺损的实验研究 中华普通外科学文献(电子版)2007,1(3):146-149
[12]王金生,储高峰等.游离腹膜管状成形移植术修复胆道损伤.中华外科杂志,1990,28(10):602-603
[13]Sandblon P,Tabrizian M,Rigo M,et al.Repair of common bile duet defect using the gallbladder on cystic duet as apedieled graft.Surg Crynecol Obstet,1975,140(3):425-432
[14]刘玉杰,厚景海.利用带蒂翻转的胆囊浆膜修复左肝管损伤一例[J].中华外科杂志,1981,19(5):198.
[15]黄志强,何振平,周永碧,等.用带血管蒂的黏膜瓣修复胆管狭窄[J].中华外科杂志,1986,24(9):532-526.
[16]Sanchez RM,Halsted GO,Trivedi RR.Common bile duct repair with serosal onlay technique[J].Am J Surg,1978,135(2):258-259.
[17]Senning A.Correction of common bile duct stricture by onlay patch of duodenum[J].World J Sorg,1979,3(6):775-779.
[18]彭其芳,冉瑞图.胃右血管蒂胃窦前壁浆肌瓣修补胆管缺损的实验研究[J].中华外科杂志,1988,26(2):101-102.
[19]焦强,张文春,徐华胜,等.移植带蒂大网膜修复胆总管缺损6例.临床军医杂志,2001,29(1):99。
[20]蔡景修,王敖川,杨丹翰,等.高位胆管狭窄合并肝内胆管结石的外科治疗[J].中华外科杂志,1988,26(8):532-534.
[21]Scudamore CH,Becket DB,Fache JS,et al.Human amnion as a bioprosthesis for bile duct reconstruction inthe pig.Am J Surg,1988,155(3):635
[22]组织工程化人工胆管材料学研究进展.解放军医学杂志,2007,32(3)
[23]Peabody CN,Millman M.Vitallium tube repair of a bile duct stricture.Aquarter-century survivor[J].Am J Surg,1972,124(9):413-415.
[24]Gulati SM,Iyengar B,Thusoo TK,et al.Use of Dacron velour in choledochoplastyl An experimental study.Am Surg,1983,49(8):49
[25]Hanung H,Kirchner R,Baba N,et al.Histological,laboratory,and X-ray findings after repair of the common bile duct with a Teflon graft.World J Stag,1978,2(5):639
[26]许建衡,孙淑卿,孙淑明,等.一种新型人工胆管的实验研究.肝胆外科杂志,1997,5(2):122-124
[27]张洁,李东,李健宁.管状膨体聚四氟乙烯用于组织工程支架材料的动物实验研究[J].中国美容医学,2004,13(6):650-1651
[28]Ruka M,Rowinski WA,Lipski M,et al.Expanded polytetrafluoro-ethylene grafts in restoring bile drainage in dogs.Z Exp Chit Trans-plant Kunstliche Organe,1987,20(6):317
[29]Mendelowitz DS,Bead JM Expanded polytetrafluoroethylene in re-construction of the canine biliary system.Am J Surg,1982,143(2):221
[30]Gomez NA,Alvarez LR,Mite A,et al.Repair of bile duct injurieswith Gore-Tex vascular grafts:experimental study in dogs.J G-astroi-ntest Surg,2002,6(1):116
[31]S.Nakashima,T.Nakamura,K.Miyagava,et al.In situ tissue engineering of the bile duct using polypropylene mesh-collagen tubes.In J Artificial Organs,2007,30(1):75-85
[32]膨体聚四氟乙烯补片修复胆管缺损的实验研究.中国修复重建外科杂志,2001 15(5):305-307
[33]Miyazwa M,Torii T,Toshimitsu Y,et al.A tissue-engineered arti-ficial bile duct grown to resemble the native bile duet.Am J Tram-plant,2005,5(6):1541
[34]Mutter D,Aprahaian M,Evrand S,et al.Biomaterials for primary closure of a choledochotomy in dogs[J].Eur Surg Res,1996,28(1):32-38.
[35]Rosen M,Ponsky J,Petras R,et al.Small intestinal submueosa as a bioseaffold for biliary tract regeneration.Surgery,2002,132(3):480
[36]Rosen M,Ponsky J,Petras R,et al.Novel bile duct repair for bleed-ing biliary anastomatic variees:case report and literature review.J Gastrointest Surg,2005,9(2):832
[37]Gomez NA,Zapatier JA,Vargas PE1 Re:"Small intestinal submuco-sa as a bioscaffold for biliary tract regeneration." Surgery,2004,135(4):460
[2]黄志强.医源性胆道损伤:老问题.新意义[J].中国实用外科杂志,1999,(8):451.
[3]李海民,高志清.医源性胆管损伤再手术原因分析及防治[J].中华肝胆外科杂志,2002,8(6):340
[4]Takatsuki M,Yanaga K,Okudaira S,et al.Duct-to-duct biliary reconstruction in adult-to-adult living donor liver transplantation[J].Clinical Transplantation,2002,16:345-349
[5]刘有生,解兴俊,丁春辉等.带血管蒂胃壁修复肝外胆管缺损12例报告[J].中国实用外科杂志,1997,17(11):644
[6]刘建明,马利林,施公胜.壁层腹膜修复胆管缺损模型组织中转化生长因子β_1的表达[J]南通医学院学报,2004,24(4):392-394
[7]刘亚光,张文福,牛力春等.带蒂胆囊瓣转移修补肝外胆管壁缺损[J].西北国防医药杂志,2000,12(4):285-286
[8]李振水,李春林,赵延玲等.带蒂空肠瓣移植修复肝外胆管缺损九例报告[J].齐鲁肿瘤杂志,1999,6:124-125
[9]Comez NA,Alvarez LR,Mite A,et al.Repair of bileduct injuries with Gore-Tex vas -cular grafts:experimental study in dogs[J]Gastrointest Surg,2002,6(1):116
[10]任为,时德.胆管修复与重建材料的研究及其临床应用[J],中国普通外科杂志,20022(11):109-110
[11]窦春青,周宁新.组织工程化人工胆管材料学研究进展[J].解放军医学杂志,2007,3(32):672-673
[12]Livesey SA,Herndon DN,Hollyoak MA,et al.Transplanted acellular allograft dermal matrix.Potential as a template for the reconstruction of viable dermis[J].Transplantation,1995,60:1-9.
[13]Wainwright DJ.Use of an acellular allografe dermal matrix(ALLoDerm) in the management of full-thickness burns[J].Burns,1995,21:243-248.
[14]刘流,梁德江,袁申鹏飞等.脱细胞膀胱细胞外基质作为膀胱替代材料的实验研究[J].中华实验外科杂志,1999,16(2):181-182
[15]李健,李志强,杨汉林.脱细胞异体真皮基质口腔组织补片在颌面外科的应用[J].医学临床研究,2004,9(21):1070
[16]杨晓平,卜建国,蔡秀军.腹腔镜胆囊切除术的手术时间对机体应激反应的影响[J].中国微创外科杂志,2007,9(7):914
[17]Terblanche J,Allison HF,Northover JM.An ischemia basis for biliary strictures[J ].Surgery,1988,94:52-57
[1]Tocchi A,Mazzoni G,Liotta G,et al.Late development of bile duct cancer in patient s who had biliary-enteric drainage for benign disease:a follow-up study of more than 1,000 patients.Ann Surg,2001,234(1):210-214
[2]Ruka M,Rowmski WA,Lipski M,et al.Expanded polytetrafluoroethylene grafts m restoring bile drainage in dogs.Z Exp Chir Transplant Kunstliche Organe,1987,20(6):317-323
[3]G(?)mez NA,Alvarez LR,Mite A,et al.Repair of bile duct injuries with Gore-Tex vascular grafts:experimental study in dogs.J Gastrointest Surg,2002,6(1):116=120
[4]Nakashima S,Nakamura T,Miyagawa K,et al.In situ tissue engineerm8 of the bile duct using polypropylene mesh-collagen tubes.Int J Artif Organs,2007,30(1):75-85
[5]Miyazawa M,Torii T,Toshimitsu Y,et al.A tissue=engineered artificial bile duct grown to resemble the native bile duct.Am J Transplant,2005,5(6):1541-1547
[6]Rosen M,Ponsky J,Petras R,et al.Small intestinal submucosa as a bioscaffold for biliary tract regeneration.Surgery,2002,132(3):480-486
[7]osen M,Ponsky J,Petras R,et al.Novel bile duct repair for bleeding biliary anastomatic varices:case report and literature review.J Gastrointest Surg,2005,9(2):832
[8]Livesey SA,Hemdon DN,Hollyoak MA,et al.Transplanted acellular allograft dermal matrix. Potential as a template for the reconstruction of viable dermis[J].Transplantation,1995,60:1-9.
[9]Wainwright DJ.Use of an acellular allografe dermal matrix(ALLo-Derm) in the management of full-thickness burns[J].Bums,1995,21:243-248
[10]林健,郝金瑞,金杰等。人同种异体真皮脱细胞真皮基质在尿道重建中的临床应用。中华医学杂志,2005,85(15):1057-1059
[11]刘流,梁德江,申鹏飞等.组织工程学材料替代输尿管缺损的动物实验及临床应用.中华泌尿外科杂志,1999,20(10):604-607
[12]傅小兵,王德文,主编.创伤修复基础[M].第1版.北京:人民军医出版社,1997.12
[13]Wahl SM.The role of transforming growth facto r-beta in inflammatory p rocesses[J].Imm unol Res,1991,10:249
[14]Border WA,Noble NA.Transforming growth factorβin tissue fibrosis.N Eng J Med,1994,10:1286-1292.
[15]任为,时德膨体聚四氟乙烯补片修复胆管缺损的实验研究.中国修复重建外科杂志,2001 15(5):305-307
[1]Jason K,Melissa S,et al.Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy perioperative results in 200 Patients.Annals of Surgery,2005, 241(5):786-795
[2]Bismuth H,Majno PE.Biliary strictures:classification based on the principles of surgical treatment.World J Surg,2001,25(10):1241-1244
[3]刘海峰。胆肠吻合术的重新评估。肝胆胰外科杂志,2006,18(4):264-265
[4]Tocchi A,Mazzoni G,Liotta G,et al.Late development of bile duct cancer in patients who had biliary-enteric drainage for benign disease:a follow-up study of more than 1,000 patients.Ann Surg,2001,234(2):210-214.
[5]马颂章,李训虎,李次会等。用于腹壁缺损修复的新材料—脱细胞后的组织基质材料。外科理论与实践,2005,10(2):188-189
[6]林健,郝金瑞,金杰等。人同种异体真皮脱细胞基质在尿道重建中的临床应用。中华医学杂志,2005,85(15):1057-1059
[7]张伟,胡敏,王恩博等。脱细胞异体真皮基质修复口腔黏膜缺损的临床研究。中华口腔医学杂志,2005,40(3):241-243
[1]何振平,别平,柳凤轩 胆管狭窄替代性组织修复的再认识.肝胆胰外科杂志,2003,16(1):16-18
[2]夏亮芳.医源性胆管损伤的预防和治疗[J].普外临床,1993,(8)4:201.
[3]Belzer FO,Mck Watts J,Rossi RL.Auto-reconstruction of the common bile duct after venous patch graft.Ann Surg,1965,162(3):346-355
[4]夏盛城,严仁俊.小切口胆囊切除术282例胆管损伤的预防[J].南通医学院学报,1988,18(1):118.
[5]Halpern Z,Rubin M,Harach G,et al.Bile and plasma lipid composi-tion in non-obese normo-lipidemic subjects with and without eholesterolgallstones[J].Liver,1993,13(5):246-252.
[6]Krahenbuhl L,Selaras G,Wente WN,et al.Incidence,risk factors,andprevention of biliary tract injurie during laparoscopic cholecysistectomy in suitzerland[J].World J Surg,2001,29(100):1325-1328.
[7]Tocehi A,Mazzoni G,Liotta G,et al.Late development of bile duet cancer in patient s who had biliary-enteric drainage for benign disease:a follow-up study of more t hart 1,000 patients.Ann Surg,2001,234:210-214.
[8]黄志强.空肠吻合方式与抗返流设计.见:黄志强胆道外科学[M].济南:山东科学技术出版社,1998.736.
[9]VILA JJ,LLUNAJ,SALAT,et al.Hepatoporto-appendieostomy.Our experience in 3 cases of biliary cystic disease[J].CirPediatr,1997,10(2):82-85.
[10]Delarue A,Chappuis J P,Esposito C,et al.Is the appendix graft suitable for routine biliary surgery in children ?[J].J Pediatr Surg,2000,35(9):1312-1316.
[11]刘会春,张培新,崔培元,等.自体静脉段移植修复胆管缺损的实验研究 中华普通外科学文献(电子版)2007,1(3):146-149
[12]王金生,储高峰等.游离腹膜管状成形移植术修复胆道损伤.中华外科杂志,1990,28(10):602-603
[13]Sandblon P,Tabrizian M,Rigo M,et al.Repair of common bile duet defect using the gallbladder on cystic duet as apedieled graft.Surg Crynecol Obstet,1975,140(3):425-432
[14]刘玉杰,厚景海.利用带蒂翻转的胆囊浆膜修复左肝管损伤一例[J].中华外科杂志,1981,19(5):198.
[15]黄志强,何振平,周永碧,等.用带血管蒂的黏膜瓣修复胆管狭窄[J].中华外科杂志,1986,24(9):532-526.
[16]Sanchez RM,Halsted GO,Trivedi RR.Common bile duct repair with serosal onlay technique[J].Am J Surg,1978,135(2):258-259.
[17]Senning A.Correction of common bile duct stricture by onlay patch of duodenum[J].World J Sorg,1979,3(6):775-779.
[18]彭其芳,冉瑞图.胃右血管蒂胃窦前壁浆肌瓣修补胆管缺损的实验研究[J].中华外科杂志,1988,26(2):101-102.
[19]焦强,张文春,徐华胜,等.移植带蒂大网膜修复胆总管缺损6例.临床军医杂志,2001,29(1):99。
[20]蔡景修,王敖川,杨丹翰,等.高位胆管狭窄合并肝内胆管结石的外科治疗[J].中华外科杂志,1988,26(8):532-534.
[21]Scudamore CH,Becket DB,Fache JS,et al.Human amnion as a bioprosthesis for bile duct reconstruction inthe pig.Am J Surg,1988,155(3):635
[22]组织工程化人工胆管材料学研究进展.解放军医学杂志,2007,32(3)
[23]Peabody CN,Millman M.Vitallium tube repair of a bile duct stricture.Aquarter-century survivor[J].Am J Surg,1972,124(9):413-415.
[24]Gulati SM,Iyengar B,Thusoo TK,et al.Use of Dacron velour in choledochoplastyl An experimental study.Am Surg,1983,49(8):49
[25]Hanung H,Kirchner R,Baba N,et al.Histological,laboratory,and X-ray findings after repair of the common bile duct with a Teflon graft.World J Stag,1978,2(5):639
[26]许建衡,孙淑卿,孙淑明,等.一种新型人工胆管的实验研究.肝胆外科杂志,1997,5(2):122-124
[27]张洁,李东,李健宁.管状膨体聚四氟乙烯用于组织工程支架材料的动物实验研究[J].中国美容医学,2004,13(6):650-1651
[28]Ruka M,Rowinski WA,Lipski M,et al.Expanded polytetrafluoro-ethylene grafts in restoring bile drainage in dogs.Z Exp Chit Trans-plant Kunstliche Organe,1987,20(6):317
[29]Mendelowitz DS,Bead JM Expanded polytetrafluoroethylene in re-construction of the canine biliary system.Am J Surg,1982,143(2):221
[30]Gomez NA,Alvarez LR,Mite A,et al.Repair of bile duct injurieswith Gore-Tex vascular grafts:experimental study in dogs.J G-astroi-ntest Surg,2002,6(1):116
[31]S.Nakashima,T.Nakamura,K.Miyagava,et al.In situ tissue engineering of the bile duct using polypropylene mesh-collagen tubes.In J Artificial Organs,2007,30(1):75-85
[32]膨体聚四氟乙烯补片修复胆管缺损的实验研究.中国修复重建外科杂志,2001 15(5):305-307
[33]Miyazwa M,Torii T,Toshimitsu Y,et al.A tissue-engineered arti-ficial bile duct grown to resemble the native bile duet.Am J Tram-plant,2005,5(6):1541
[34]Mutter D,Aprahaian M,Evrand S,et al.Biomaterials for primary closure of a choledochotomy in dogs[J].Eur Surg Res,1996,28(1):32-38.
[35]Rosen M,Ponsky J,Petras R,et al.Small intestinal submueosa as a bioseaffold for biliary tract regeneration.Surgery,2002,132(3):480
[36]Rosen M,Ponsky J,Petras R,et al.Novel bile duct repair for bleed-ing biliary anastomatic variees:case report and literature review.J Gastrointest Surg,2005,9(2):832
[37]Gomez NA,Zapatier JA,Vargas PE1 Re:"Small intestinal submuco-sa as a bioscaffold for biliary tract regeneration." Surgery,2004,135(4):460