CAJ | 학술논문

目的:探讨胆囊间置肝管十二指肠吻合的可行性.方法:杂种犬15只,其中对照组5只,行胆囊活检术;实验组10只,行胆囊间置肝管十二指肠吻合术.术中和术后3个月测胆囊的静息压力、胆总管的静息压力以及Oddi括约肌或胆囊管十二指肠吻合口的通过压力和抗返流压力.行口服碘蕃酸胆囊造影检查.结果:动物全部存活,对照组和实验组术后3个月体重差异不显著.实验组动物术后3个月再次手术中,胆囊充盈,壁薄有弹性,胆汁清亮无食物残渣.胆囊的静息压力由0.91±0.47 kPa升至1.55±0.56 kPa;胆总管静压1.28±0.39 kPa,Oddi括约肌通过压3.40±0.89 kPa;胆囊管十二指肠吻合口的通过压力4.35±0.97 kPa,抗返流压力18.99±5.69kPa.再次手术后胆囊持续引流液中未见食物.胆囊造影示:对照组和实验组口服碘蕃酸12小时后,胆囊均显影,但实验组中有2例显影淡.脂肪餐后1小时,胆囊影均消失.结论:胆囊间置肝管十二指肠吻合后,胆囊保留着贮存、浓缩和排泄胆汁的功能,胆囊管远端的括约肌样结构具备有效的抗十二指肠向胆囊内返流的功能.
목적:탐토담낭간치간관십이지장문합적가행성.방법:잡충견15지,기중대조조5지,행담낭활검술;실험조10지,행담낭간치간관십이지장문합술.술중화술후3개월측담낭적정식압력、담총관적정식압력이급Oddi괄약기혹담낭관십이지장문합구적통과압력화항반류압력.행구복전번산담낭조영검사.결과:동물전부존활,대조조화실험조술후3개월체중차이불현저.실험조동물술후3개월재차수술중,담낭충영,벽박유탄성,담즙청량무식물잔사.담낭적정식압력유0.91±0.47 kPa승지1.55±0.56 kPa;담총관정압1.28±0.39 kPa,Oddi괄약기통과압3.40±0.89 kPa;담낭관십이지장문합구적통과압력4.35±0.97 kPa,항반류압력18.99±5.69kPa.재차수술후담낭지속인류액중미견식물.담낭조영시:대조조화실험조구복전번산12소시후,담낭균현영,단실험조중유2례현영담.지방찬후1소시,담낭영균소실.결론:담낭간치간관십이지장문합후,담낭보류착저존、농축화배설담즙적공능,담낭관원단적괄약기양결구구비유효적항십이지장향담낭내반류적공능.
Objective:To investigate the feasibility to interpose the gallbladder between common hepatic duct and duodenum for bile duct reconstruction in animal models.Methods:This experiment was carried out on 15 dogs.Of them,the gallbladder interposition between the common hepatic duct and duodenum was performed on 10 and the gallbladder biopsy on 5.A resting pressure of gallbladder and an antireflux pressure from duodenum to the interposed gallbladder were measured.The concentration and storage function of the interposed gallbladder were evaluated by oral cistobil cholecystography.Results:All animals were alive at termination of the study 12 weeks postoperatively.There was no difference in body weight between the two groups.When the experimental group was reoperated on,the bile in the interposed gallbladder was clear and without food residue.The resting pressure in gallbladder increased from 0.91±0.47 kPa prcoperation to 1.55±0.56 kPa postoperation.The anti-reflux pressure from duodenum to the interposed gallbladder was 18.99±5.69 kPa.Postoperative X-ray exams revealed that the interposed gallbladder pressrved the bile storage,concentration and excretion functions.Conclusions;The interposition of gallbladder can be used to reconstruct the bile duct and preserve the functions of the gallbladder.