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    Dubinin S. I., Malik S. V., Ulanovska-Tsyba N. A., Lavrenko D. O., Ryabushko O. B., Perederiy N. O.

    PLASTIC SURGERY OF CHOLEDOCHUS BEING PERFORMED BY CYSTIC DUCT STUMP


    About the author: Dubinin S. I., Malik S. V., Ulanovska-Tsyba N. A., Lavrenko D. O., Ryabushko O. B., Perederiy N. O.
    Heading EXPERIMENTAL MEDICINE
    Type of article Scentific article
    Annotation In this work, under conditions of experimental researches, the model of the common bile duct plastic in emergency situation using cystic duct stump with further hepatotomy on external drains has proposed. The results of experimental studies may be appropriate for use in the clinic. Model of experiment: after premedication, which completely inhibited protective reflexes and motor reactions of animals under hexenal anesthesia performed by laparotomy of S.P.Fedorov type. The subserous cholecystectomy "from the bottom" in the modification of V.S.Shevchenko has performed. Fusion area of the common bile duct with cystic duct 2 cm long segment of the common bile duct was drawn out. The proximal end is tied tightly twice. At the distal two threads - holders are imposed. Paid attention to the maximum saving of supply of cystic duct stump and supraduodenal end of choledochus. With atraumatic needles and "P" -like stitches anastomosis performed as "end to end " connecting cystic duct stump with choledochus supraduodenal part. Zone of anastomosis has streghted. In order to prevent postoperative intraductal hypertension an operation of hepaticostomy on the external drainage has added. Histological study of the early period ( 3 - 14 days) on anastomotic sites an inflammatory infiltration has observed. On the wall there was congestion of bile, dystrophy and desquamation of the mucosa epithelium. In the later periods of the experiment (30 - 90 days) reduction of edema in all membranes of anastomosis is observed. In its diameter is clearly shown much layers of the epithelium on the background of fibroblastic reaction and collagen formation. Blood vessels are dilated on the background of stasis and increased amount of formed elements. In terms of long-term experiment ( 360 days) signs of inflammatory response is almost absent. In the area of "anastomosis" connection its entire clearly formed epithelial covering of the presence of collagen fibers. All layers anastomosis newly observed net of blood and lymph vessels, almost without stasis . In all experiments there was clearly formed functional anastomosis . Thus, the study of the possibilities of cystic duct stump for plastics defect of the common bile duct with significant diastase of its ends, revealed a number of features. In an extreme situation, due to accidental damage or even partial removal of a duct when to renew its integrity through significant parts of diastase is impossible, the surgeon can perform a replacement of defect formed via cystic duct stump . This possibility is always present in clinics, if the patient did not have a history of cholecystectomy. Anatomical integrity , uniformity of histological structure, functional identity of cystic duct with other parts of magistral biliary system provides a wide perspectives of its use in an emergency to restore the integrity of choledochus . Sequential implementation of all elements of the proposed model of plastic with maximum airproof of mucosa and use "P" -like stitches helps to create an active anastomosis , thereby successfully resolve an extreme situation. Histological study of an anastomosis area strongly suggest a significant epithelization of anastomotic diameter, although some areas of collagen fibers are present too. Correctly performed anastomosis created favorable conditions for the providing of physical and biological airproof of sutures. Functioning anastomosis is created. The results obtained due to experiment opens the possibility of their use in the clinic.
    Tags cholecystitis, choledochus plastic defect
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    Publication of the article «World of Medicine and Biology» №1(48), 2015 year, 119-122 pages, index UDK 616.366 – 002- 092.9