与胆肠吻合术相比，肝胆管切开术术后肝胆管结石风险较低。

Comparatively lower postoperative hepatolithiasis risk with hepaticocholedochostomy versus hepaticojejunostomy.

机构信息

Department of Hepatobiliary Surgery, Fuzong Clinical College, Fujian Medical University, Fuzhou 350025, China.

出版信息

Hepatobiliary Pancreat Dis Int. 2010 Feb;9(1):38-43.

PMID:20133227

Abstract

BACKGROUND

Optimal surgical technique plays a key role in preventing the postoperative recurrence of hepatolithiasis. Tian et al developed the subcutaneous tunnel and hepatocholangioplasty using the gallbladder (STHG) technique and applied it in hepatolithiasis patients who had an approximately normal gallbladder and sphincter of Oddi. However, the technique is controversial. In the present study, a canine model was established for hepatocholangioplasty (HC) and hepaticojejunostomy (HJ) to simulate STHG and Roux-en-Y cholangiojejunostomy in the clinic, respectively. Then, the alterations of bile components in the vicinity of the anastomosis were compared. This may provide an experimental guide for choosing an optimal technique for the treatment of hepatolithiasis in the clinic.

METHODS

The animals were randomly separated into a control group (5 dogs) and a model group (stenosis of the common bile duct; 24 dogs). The 24 dogs in the model group were randomly divided into an HC group and an HJ group (12/group). Bile was collected from the bile duct at 1 and 5 months after the operation, and the bile components were determined.

RESULTS

The levels of total bile acid, cholesterol, total bilirubin, and phospholipid in the HC group were higher than those in the HJ group (P<0.05). However, no statistical difference was seen in unconjugated bilirubin and calcium ions. The mucin level in bile in the HC group was lower than that in the HJ group at 5 months after the operation (P<0.05). The postoperative lipid peroxidation level was remarkably lower than that in the HJ group (P<0.05). However, the superoxide dismutase level was remarkably higher than that in the HJ group (P<0.05). Finally, a significant difference was found in the positive bacterial culture rate in bile between the groups.

CONCLUSION

Changes of bile components near the anastomosis after HC might be more preferable for preventing hepatolithiasis formation than HJ.

摘要

背景

优化的手术技术在预防肝胆管结石术后复发方面起着关键作用。田等人开发了一种皮下隧道和胆囊肝胆管成形术（STHG）技术，并将其应用于具有大致正常胆囊和Oddi 括约肌的肝胆管结石患者。然而，该技术存在争议。本研究建立了犬肝胆管成形术（HC）和肝肠吻合术（HJ）模型，分别模拟临床中的 STHG 和 Roux-en-Y 胆肠吻合术，然后比较吻合口附近胆汁成分的变化。这可能为临床治疗肝胆管结石选择最佳技术提供实验指导。

方法

动物随机分为对照组（5 只狗）和模型组（胆总管狭窄；24 只狗）。模型组的 24 只狗随机分为 HC 组和 HJ 组（每组 12 只）。术后 1 个月和 5 个月，从胆管采集胆汁，测定胆汁成分。

结果

HC 组总胆汁酸、胆固醇、总胆红素和磷脂水平均高于 HJ 组（P<0.05）。但未结合胆红素和钙离子无统计学差异。术后 5 个月，HC 组胆汁中粘蛋白水平低于 HJ 组（P<0.05）。术后脂质过氧化水平明显低于 HJ 组（P<0.05）。但超氧化物歧化酶水平明显高于 HJ 组（P<0.05）。最后，两组胆汁阳性细菌培养率有显著差异。