Yamamoto T, Hamanaka Y, Suzuki T
Department of Surgery II, Yamaguchi University School of Medicine, Ube, Japan.
Nihon Geka Gakkai Zasshi. 1991 Sep;92(9):1288-91.
The purpose of this study was to evaluate the intestinal microflora and the composition of various bile acids in jejunal fluid following B-I and B-II types of biliary reconstruction in dogs. B-1 type reconstruction, in which the biliary tract was directly anastomosed to the food passing tract, was performed in 8 dogs, which received cholecystoduodenostomy (group C-D) and in 8 which received cholecystojejunostomy (group C-J). B-II type reconstruction by Roux-Y cholecystojejunostomy, in which bile flowed into the jejunal limb, was performed in 8 dogs (group R-Y). Incidences of detection of gram-positive, gram-negative and anaerobic bacteria were as follows: 33%, 33% and 6% in the jejunal fluid obtained at initial operation, 67%, 67% and 33% in group C-D, 83%, 67% and 33% in group C-J, and 75%, 88% and 75% in group R-Y. In six dogs in group R-Y, unconjugated or secondary bile acids in the jejunal fluid increased, while these increases were observed in only two dogs in group C-J and in no dogs in C-D. Unconjugated and secondary bile acids were more likely to increase following B-II type reconstruction than following B-I type reconstruction. These findings are thought to be associated with bacterial overgrowth in the jejunal loop. These results suggest that B-II type reconstruction, in which bilio-enterostomy is exposed with infected intestinal fluid and unconjugated and secondary bile acids, is inferior in preventing ascending cholangitis.
本研究的目的是评估犬行B-I型和B-II型胆道重建术后空肠液中的肠道微生物群及各种胆汁酸的组成。8只犬接受胆囊十二指肠吻合术（C-D组），8只犬接受胆囊空肠吻合术（C-J组），进行B-1型重建，即将胆道直接吻合至食物通过道。8只犬行Roux-Y胆囊空肠吻合术进行B-II型重建，使胆汁流入空肠袢（R-Y组）。革兰氏阳性菌、革兰氏阴性菌和厌氧菌的检出率如下：初次手术时获取的空肠液中分别为33%、33%和6%；C-D组分别为67%、67%和33%；C-J组分别为83%、67%和33%；R-Y组分别为75%、88%和75%。R-Y组6只犬空肠液中未结合或次级胆汁酸增加，而C-J组仅2只犬出现此类增加，C-D组未出现。与B-I型重建相比，B-II型重建后未结合和次级胆汁酸更易增加。这些发现被认为与空肠袢内细菌过度生长有关。这些结果表明，B-II型重建中胆肠吻合口暴露于感染的肠液以及未结合和次级胆汁酸中，在预防上行性胆管炎方面较差。
