CAJ | 학술논문

The authors designed a new operation,artificial antireflux spur valve, to treat conge nital choledochal cysts,which was performed in 31 cases with satisfactory results.Good antireflux effect was achieved during and after operation when checked on table and after.All the 22 followed-up cases were uneventful.The main points of the procedure include:1.excision of the free part of the cyst wall and the gall bladder by Bovle in full thickness and peeling off of the mucosa only of the rest part which adheres to portal vessel so as to lessen the oozing surface.2.taking short jejunal segment of 10 cm with pedicle between hepatic duct and duodenum to avoid redundan cy.3.construction of a spar valve at the duodenal anastomosis to prevent reflux.54 dogs were used in a series of animal experi ments with the results as follows:1.optimal length of spur-valve being 5 cm which will maintain a normal intra-biliary pressure(20 mmHg)to prevent reflux on normal peristal sis, and will keep close against a reflux pres sure(41 mmHg)to prevent reflux from intestinal obstruction.2.the anti-reflux effect of the spur showing some decrease one month after operation,but recovering its function after the 2nd month.3.barium study showing full reflux filling into a con ventional 40 cm Roux-Y limb,but no more than 5 cm reflux into a spur valve bile duct.4.postoperative gastric analysis being normal.5.autopsy revealing no food particles or inflammation in the artificial bile duct,nor ulcers in stomach or duodenum,However the authors emphasize that to observe long-term results a large number of cases should be followed up for a long period of time.