【摘要】 目的:探讨胆支肠袢套叠瓣成形在胆肠Roux-en-Y吻合重建胆道术后的抗反流机制。方法:20只成年家兔随机均分为实验组和对照组。在胆总管结扎后,实验组行胆囊空肠Roux-en-Y吻合胆支肠袢套叠瓣成形胆道重建术,对照组仅行单纯胆囊空肠Roux-en-Y吻合术。术后饲养3个月,测量两组胆道顺流压和逆流压,并在测压同时给予造影。结果:胆道顺流压实验组为(5.91±1.46)cmH2O(1 cmH2O=0.098 kPa),对照组为(4.82±0.39)cmH2O;逆流压实验组为(14.32±1.67)cmH2O,对照组为(4.90±0.37)cmH2O。统计分析显示,两组间顺流压的差异无统计学意义(P>0.05),但逆流压实验组明显大于对照组(P<0.01);实验组逆流压明显大于自身顺流压(P<0.01),而对照组两者间差异无统计学意义(P>0.05)。造影结果显示,套叠瓣能阻止造影剂进入其上方胆支肠袢。结论:胆肠Roux-en-Y吻合重建胆道术后胆支肠袢套叠瓣通过增加Y袢胆臂逆流压而发挥抗反流作用。更多还原

【Abstract】 Objective:To investigate the mechanism of the antireflux action of intussusception valve constructed in the biliary intestinal limb of Roux-en-Y cholecystojejunostomy after biliary tract surgery. Methods: Twenty adult rabbits were equally randomized into the experimental group and control group.After common bile duct ligation,the biliary reconstruction in the experimental group was performed using Roux-en-Y cholecystojejunostomy with an intussusception valve created in the biliary intestinal limb,while the procedure in the control group was Roux-en-Y cholecystojejunostomy alone.Rabbits of the two groups were bred 3 months after surgery,and then their isoperistaltic pressure(IPP) and antiperistaltic pressure(APP) in the reconstructed biliary tract was measured,meanwhile a contrast X-ray examination was also performed. Results: The IPP values of the experimental group and control group were(5.91±1.46) cmH2O(1 cm H2O=0.098 kPa) and(4.82±0.39) cmH2O,and the APP values of them were(14.32±1.67) cmH2O and(4.90±0.37) cmH2O,respectively.Statistical analysis indicated that the APP value of experimental group was significantly higher than that of control group(P<0.01),but the IPP values between the two groups had no statistical difference(P>0.05);the APP values were significantly higher than the IPP values in experimental group(P<0.01),but the two values showed no statistical difference in control group(P>0.05).Contrast examination showed that the intussusception antireflux valve in the biliary limb of the small bowel could restrict the entering of contrast material into its upper segment. Conclusion: Intussusception valve exerts effective action against reflux in the biliary tract reconstructed with Roux-en-Y biliary-enteric anastamosis through increasing APP of the biliary limb of the Y structure.更多还原