Department of Surgery and Anatomy, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
Eur J Gastroenterol Hepatol. 2012 Sep;24(9):1039-50. doi: 10.1097/MEG.0b013e3283551fed.
The influence of choledochoduodenostomy and choledochojejunostomy on the repair of hepatic lesions secondary to biliary obstruction is not well known. The aim of the present study was to compare the effects of choledochoduodenostomy and choledochojejunostomy on the recovery of these lesions in rats with biliary obstruction.
Rats subjected to 4 weeks of biliary obstruction underwent choledochoduodenostomy (n=10) or choledochojejunostomy (n=10). The following variables were measured: total bilirubin, alkaline phosphatase, aminotransferases, and albumin. Hepatic mitochondrial energy metabolism was evaluated by calculating the respiratory control ratio and the oxidative phosphorylation index. Hepatic morphometry was used to estimate the mass of the hepatocytes, bile ducts, and fibrosis, as well as the hepatic stellate cell count.
After choledochoduodenostomy and choledochojejunostomy, there was a regression in cholestasis and a reduction in the oxidative phosphorylation index. However, the total bilirubin, alkaline phosphatase, albumin, and respiratory control ratio values improved only after choledochojejunostomy. The mass of the liver, spleen, and fibrosis was reduced after both choledochoduodenostomy and choledochojejunostomy, but the number of hepatic stellate cells increased. After choledochojejunostomy, the hepatic mass recovered completely, and the spleen mass was significantly reduced compared with that after choledochoduodenostomy. After both choledochoduodenostomy and choledochojejunostomy, enterobiliary reflux, biliary contamination, and an exacerbation in hepatic inflammation developed.
Choledochojejunostomy was more effective than choledochoduodenostomy, but both techniques induced enterobiliary reflux and biliary contamination, which may explain the maintenance of hepatic alterations, especially after choledochoduodenostomy.
胆总管十二指肠吻合术和胆总管空肠吻合术对胆道梗阻后继发肝损伤的修复影响尚不清楚。本研究旨在比较胆总管十二指肠吻合术和胆总管空肠吻合术对胆道梗阻大鼠肝损伤恢复的影响。
4 周胆道梗阻的大鼠行胆总管十二指肠吻合术（n=10）或胆总管空肠吻合术（n=10）。测量总胆红素、碱性磷酸酶、转氨酶和白蛋白。通过计算呼吸控制比和氧化磷酸化指数评估肝线粒体能量代谢。肝形态计量学用于估计肝细胞、胆管和纤维化的质量以及肝星状细胞计数。
胆总管十二指肠吻合术和胆总管空肠吻合术后，胆汁淤积消退，氧化磷酸化指数降低。然而，仅在胆总管空肠吻合术后，总胆红素、碱性磷酸酶、白蛋白和呼吸控制比值才得到改善。胆总管十二指肠吻合术和胆总管空肠吻合术后，肝脏、脾脏和纤维化的质量减轻，但肝星状细胞数量增加。胆总管空肠吻合术后，肝脏质量完全恢复，脾脏质量明显低于胆总管十二指肠吻合术。胆总管十二指肠吻合术和胆总管空肠吻合术后均发生胆肠反流、胆汁污染和肝炎症加重。
胆总管空肠吻合术比胆总管十二指肠吻合术更有效，但两种技术均引起胆肠反流和胆汁污染，这可能解释了肝损伤的维持，尤其是在胆总管十二指肠吻合术后。
