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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。
Objective: To explore the feasibility of interhepatic duodenal anastomosis. Methods: Fifteen hybrid dogs were randomly divided into control group (n = 5) and gallbladder biopsy. Experimental group (n = 10) received duodenal anastomosis. Intraoperative and postoperative 3 months measured resting pressure of the gallbladder, resting pressure of the common bile duct and sphincter of Oddi or cystic duct duodenum anastomosis through the pressure and anti-reflux pressure. Oral oral iodine acid gallbladder contrast examination. Results: The animals all survived. There was no significant difference in body weight between the control group and the experimental group at 3 months after operation. Experimental animals 3 months after surgery in the reoperation, the gallbladder filling, wall thin and flexible, clear bile without food residue. The resting pressure of the gallbladder increased from 0.91 ± 0.47 kPa to 1.55 ± 0.56 kPa; the static pressure of the common bile duct was 1.28 ± 0.39 kPa, the pressure of the sphincter of Oddi was 3.40 ± 0.89 kPa; the pressure of duodenal anastomosis through the cystic duct was 4.35 ± 0.97 kPa , Anti-reflux pressure 18.99 ± 5.69kPa. Gallbladder continued drainage after surgery no food. Gallbladder angiography showed: control group and experimental group oral iodine acid 12 hours after the gallbladder were developed, but in the experimental group, 2 cases of development of light. 1 hour after fat meal, gallbladder shadow disappeared. CONCLUSIONS: After gallbladder anastomosis of the duodenum, the gallbladder retains the function of storing, concentrating and excreting bile. The sphincter-like structure at the distal end of the cystic duct possesses an effective anti-reflux function against the duodenum.