Takada T, Yasuda H, Uchiyama K, Hasegawa H, Shikata J, Takada K
First Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
Hepatogastroenterology. 1992 Oct;39(5):470-4.
A combination of a cholecystectomy and detachment of the supportive tissue surrounding the extrahepatic bile duct results in chronic bile duct dilation. To clarify whether this cholangiectasis is due to the detachment of the surrounding tissue or to the cholecystectomy, we have studied 4 groups of adult mongrel dogs, i.e., a control group given a sham operation (n = 20), a group given cholecystectomy (n = 20), a group that had the surrounding tissue detached from the bile duct (n = 20), and a group given both a cholecystectomy and detachment of the surrounding tissue (n = 29). On examination by cholangiography at 1, 2, 3, and 4 weeks after the initial laparotomy, no significant cholangiectasis was found in dogs subjected to either cholecystectomy alone or to detachment of the surrounding tissue alone. In contrast, in dogs subjected to a cholecystectomy combined with detachment of the bile duct, the bile duct gradually dilated, resulting in significant cholangiectasis at 4 weeks. However, the intrabiliary pressure, the residual pressure, and the actual resistance value, which are indices of a passage disturbance in the sphincter of Oddi, were normal in all 4 groups. It is therefore concluded that both the extirpation of the gallbladder, and the lack of supportive tissue surrounding the bile duct were responsible for the resulting cholangiectasis.
胆囊切除术与肝外胆管周围支持组织的分离相结合会导致慢性胆管扩张。为了阐明这种胆管扩张是由于周围组织的分离还是胆囊切除术所致，我们对4组成年杂种犬进行了研究，即假手术对照组（n = 20）、胆囊切除组（n = 20）、胆管周围组织分离组（n = 20）以及胆囊切除与周围组织分离联合组（n = 29）。在初次剖腹手术后1、2、3和4周通过胆管造影检查发现，单纯接受胆囊切除术或单纯胆管周围组织分离的犬未出现明显胆管扩张。相比之下，接受胆囊切除并胆管周围组织分离的犬胆管逐渐扩张，在4周时出现明显胆管扩张。然而，作为Oddi括约肌通道紊乱指标的胆管内压力、残余压力和实际阻力值在所有4组中均正常。因此得出结论，胆囊切除以及胆管周围缺乏支持组织是导致胆管扩张的原因。
