Yamamoto T, Hamanaka Y, Suzuki T
Department of Surgery II, Yamaguchi University School of Medicine, Japan.
J Am Coll Surg. 1995 Dec;181(6):525-9.
This study evaluated the composition of various bile acids and microorganisms in the jejunal lumen after using different methods of biliary reconstruction.
A Billroth I biliary reconstruction, in which the biliary tract was directly anastomosed to the alimentary tract, was performed in 16 dogs, including eight with cholecystoduodenostomy (C-D group) and eight with cholecystojejunostomy (C-J group). A Billroth II reconstruction, involving a Rouxen-Y cholecystojejunostomy (R-Y group) in which bile flowed into the jejunal limb, was made in eight dogs. Jejunal fluid samples were used for microbial culture and bile acid assay by high-performance liquid chromatography.
The percentage of unconjugated bile acids in the R-Y group (9.96 +/- 2.17 percent) was significantly higher than that observed in the C-D group (0.11 +/- 0.05 percent), and that observed in the C-J group (1.05 +/- 0.72 percent) (p < 0.01). The detection rate of anaerobes was higher in the R-Y group than in the C-D and C-J groups.
This study suggests that due to an increase in unconjugated bile acids after the Billroth II biliary reconstruction the function of digestion and absorption is less well preserved than after the Billroth I method.
本研究评估了采用不同胆道重建方法后空肠腔内各种胆汁酸和微生物的组成。
对16只犬进行了毕罗Ⅰ式胆道重建，即将胆道直接吻合至消化道，其中8只进行胆囊十二指肠吻合术（C-D组），8只进行胆囊空肠吻合术（C-J组）。对8只犬进行了毕罗Ⅱ式重建，即采用 Roux-en-Y 胆囊空肠吻合术（R-Y组），使胆汁流入空肠袢。采集空肠液样本进行微生物培养，并通过高效液相色谱法进行胆汁酸测定。
R-Y组中未结合胆汁酸的百分比（9.96±2.17%）显著高于C-D组（0.11±0.05%）和C-J组（1.05±0.72%）（p<0.01）。R-Y组厌氧菌的检出率高于C-D组和C-J组。
本研究表明，由于毕罗Ⅱ式胆道重建后未结合胆汁酸增加，其消化和吸收功能的保存不如毕罗Ⅰ式方法。
