Rozga J, Ahrén B, Andersson R, Emody L, Wadström T, Bengmark S
Department of Surgery, Lund University, Sweden.
Br J Surg. 1991 Nov;78(11):1329-31. doi: 10.1002/bjs.1800781120.
It has been postulated that biliary infection plays a role in bile duct stricture formation. The aim of this study was to verify this hypothesis and to evaluate the effect of biliary infection on common bile duct healing. A 3-mm longitudinal choledochotomy was performed in 120 rats and closed with a continuous 11/0 Ethilon suture. Common bile duct division with end-to-end anastomosis using interrupted 11/0 Ethilon sutures was performed in another 30 rats. Biliary infection was achieved in half of the animals with retrograde injection of living 046:K1:H31 strain Escherichia coli recovered from the rat colonic content. All rats with choledochotomy, including those with biliary infection, showed no bile leakage at the suture line, and the bursting pressure at the site of choledochotomy exceeded 40 mmHg as early as 24 h. Rats with common bile duct anastomosis alone showed no stricture formation for up to 6 months after operation. All rats with biliary sepsis developed complete occlusion at the anastomosis. On scanning electron microscopy, the biliary epithelium was well preserved in all rats. The study suggests that in rats with biliary sepsis the risk of bile leakage after primary closure of the common bile duct is negligible, but biliary infection may play a critical role in common bile duct stricture formation.
据推测，胆道感染在胆管狭窄形成过程中起一定作用。本研究的目的是验证这一假说，并评估胆道感染对胆总管愈合的影响。对120只大鼠进行3毫米的胆总管纵行切开术，并用11/0 Ethilon缝线连续缝合关闭。对另外30只大鼠进行胆总管离断并采用11/0 Ethilon缝线间断缝合进行端端吻合。通过逆行注射从大鼠结肠内容物中分离出的活的046:K1:H31株大肠杆菌，使半数动物发生胆道感染。所有接受胆总管切开术的大鼠，包括发生胆道感染的大鼠，在缝合线处均未出现胆汁渗漏，胆总管切开部位的破裂压力早在24小时就超过了40 mmHg。单纯进行胆总管吻合的大鼠术后长达6个月均未出现狭窄形成。所有发生胆源性败血症的大鼠在吻合处均出现完全阻塞。扫描电子显微镜检查显示，所有大鼠的胆管上皮均保存良好。该研究表明，在发生胆源性败血症的大鼠中，胆总管一期缝合后胆汁渗漏的风险可忽略不计，但胆道感染可能在胆总管狭窄形成中起关键作用。
