胆囊结肠Roux-en-Y吻合对肝胆系统形态和总胆汁酸含量的影响

Effect of Cholecystocolonic Roux-en-Y Anastomosis on the Morphology of Hepatobiliary System and TBA Level

目的探讨胆囊结肠Roux-en-Y吻合术对家兔肝胆系统形态和总胆汁酸(TBA)含量的影响。方法 24只幼兔随机分为正常对照组、部分胆汁内分流(partial internal biliary diversion,PIBD)阳性对照组、胆囊结肠Roux-en-Y吻合组,各8只,分别实施假手术、空肠间置内分流术或胆囊结肠Roux-en-Y吻合术。术后1年行核素肝胆显像评估模型,手术当日及术后1年留取胆汁和血清标本,检测TBA浓度。核素显像完成后,处死动物同时留取肝、胆囊、结肠组织行病理组织学检查。结果观察期间3组实验兔全部存活,生长发育正常。经核素肝胆动态显像证实胆囊结肠Roux-en-Y吻合组部分胆汁自胆囊直接分流入结肠,建模成功;胆汁中平均TBA由(801.46±22.54)μmol/L下降至(214.08±12.24)μmol/L(P=0.00),均数下降73%;门静脉血中的TBA含量也呈下降表现,由(85.33±2.08)μmol/L降至(18.85±2.01)μmol/L(P=0.00),均数下降78%;肝、胆囊及结肠无明显病理损害。结论胆囊结肠Roux-en-Y吻合安全可靠,可以起到胆汁内分流作用,明显降低体内胆汁酸浓度。

Objective To study the effect of cholecystocolonic Roux-en-Y anastomosis on hepatobiliary system morphology and TBA level in rabbits. Methods Totally 24 rabbits were randomly divided into control, partial internal biliary diversion （PIBD） and cholecystocolonic Roux-en-Y anastomosis groups with 8 in each. Sham operation, jejunal interposition-shunt, or cholecystocolonic Roux-en-Y anastomosis were performed on the three groups respectively. Dynamic biligraphy was carried out in one year to evaluate the reliability of the animal model. On the operation day, bile and serum samples were collected for total bile acid（TBA） determination on the day and in one year after the operation. The liver, gallbladder, and colon tissues of the animals were harvested for pathological examination. Results All the animals survived and developed normally during the follow-up period. Biligraphy showed bile diverting into the colon directly after cholecystocolonic anastomosis, which meant that the animal model was buih successfully. The level of TBA in the sample bile decreased by 73% in average in one year from （801.46 ± 22.54） μmol/L to （214.08 ± 12.24） μmol/L; and that in the portal venous serum was decreased by a mean of 78% from （85.33 ±2.08） μmol/L to （18.85± 2.01 ） μmol/L. Pathological examination showed no marked damage to the liver, gallbladder, and colon. Conclusions Cholecystocolonic Roux-en-Y anastomosis is feasible and safe. It reduces the level of TBA by diverting bile.