Department of Surgery and Anatomy, Division of Digestive Surgery, University of São Paulo, at the Ribeirão Preto School of Medicine, Brazil.
J Surg Res. 2011 Aug;169(2):e127-36. doi: 10.1016/j.jss.2011.04.028. Epub 2011 May 14.
Bilioduodenal (BD) and biliojejunal (BJ) derivation induce enterobiliary reflux and bile stasis. Decompression of the excluded loop of the Roux-en-Y (BJD) was proposed to minimize these effects. The aim of this study was to compare the influence of these three modalities of biliary bypass on hepatic lesion repair in rats with secondary biliary fibrosis.
Rats with 15 d of biliary obstruction underwent BD, BJ, and BJD drainage and were compared with a group submitted to simulated operation (SO) and biliary obstruction (CBO). The serum values of total and fractional bilirubin, alkaline phosphatase (ALP), and aminotransferases (AST and ALT), as well as hepatobiliointestinal excretion determined with (99m)Tc-Disida, were used for comparison. In addition, we used morphometric analyses to estimate the mass of the hepatocytes, bile ducts, and liver fibrosis. We also counted hepatic stellate cells (SC).
For each of the three modalities of biliary drainage, there were significant reductions in bilirubin, AST, ALP, and the number of SCs. The recovery of the estimated mass of all histologic components occurred only after BJ and BJD; in the BD group, the estimated hepatocyte mass was reduced compared with the SO group. The residual hepatic radioactivity of (99m)Tc-Disida was greater in the BJD group than in the SO group.
The interposition of the jejunal loop between the biliary tree and the intestine may slow hepatobiliary clearance of radioactivity, even though it provides the resolution of cholestasis and is effective in recovering from hepatic lesions.
胆肠（BD）和胆肠（BJ）引流可导致胆汁反流和胆汁淤积。提出 Roux-en-Y （BJD）排除环减压以最小化这些影响。本研究的目的是比较这三种胆汁旁路方式对继发胆汁性纤维化大鼠肝损伤修复的影响。
患有 15 天胆道梗阻的大鼠接受 BD、BJ 和 BJD 引流，并与模拟手术（SO）和胆道梗阻（CBO）组进行比较。比较血清总胆红素、游离胆红素、碱性磷酸酶（ALP）和氨基转移酶（AST 和 ALT）以及（99m）Tc-Disida 测定的肝胆排泄。此外，我们还使用形态计量分析来估计肝细胞、胆管和肝纤维化的质量。我们还计算了肝星状细胞（SC）的数量。
对于三种胆汁引流方式，胆红素、AST、ALP 和 SC 数量均显著降低。只有在 BJ 和 BJD 后，所有组织学成分的估计质量才恢复；在 BD 组中，与 SO 组相比，估计的肝细胞质量减少。（99m）Tc-Disida 的残留肝放射性在 BJD 组中高于 SO 组。
在胆管树和肠之间插入空肠袢可能会减缓放射性核素的肝胆清除率，尽管它可以解决胆汁淤积并有效地恢复肝损伤。
