浅析胆道中两种流动的概念

Dual Flow in Biliary Tract: A New Concept

胆道是肝脏和胰腺分泌液的输出道,它把肝和胰联系起来,在功能上共营消化作用。把肝胆胰作为一个系统来看待,国内外近年来巳成为现实。解剖学、组织学。

The idea of dual flow is formed in fluid dynamic study of biliary tract. From canaliculi to gallbladder, bile is drived by secreting pressure of hepatocyte. The flow is even and slow, laminar in nature, called the First Bile Flow. Gallbladder contraction together with the pancreatic secreting pressure expels the bile and pancreatic fluid out of the ampulla into the duodenum. The flow is quick and in jerks or ejections, turbulent in nature, called the Second Bile Flow. Normally, bile and pancreatic fluid are Newton fluid, accommodated each other as a duct. Common bile duct is in part of the second flow, belongs to the first flow when the gallbladder is resected or cystic duct obliterated. Pancreatic fluid takes important part of the second flow, even no common channel present, but both ducts or the papilla are controlled by the same sphincter (Oddi). Measuring the angle between every two branches of the bile ducts in stereo in a clinical patient is important to interpret the bile flow pathology, such as stone formation has not yet been reported in literature, from our study, the angle value from two X-ray films of known casting directions calculated by trigonometry formula, the confluent out flow value is cosine of the combined inflows. The pressure value from T-tube represents the static pressure of the common bile duct including the sphincter resistance, is different from that obtained endoseopically while the ampulla is cannulated. Endoscopic measuring, as in ERCP, shows the pressure values of the quiet state while the gall bladder and pancreas are not activated. The papilla resistance against the duodenal regurgitation is also different from the data by T-tube. T-tube drainage under controlled pressure is recommended for reducing contamination from duodenal regurgitation. Fluid dynamics of pancreas flow is so far poorly known. Eddy flow of bile when stone or stricture present in the biliary tract gives more static pressure force to the duct wall resulting to dilatation. After bilioenterostomy.the biliary tract is no longer clean, triphasic flow, ie, solid stone or food particles, ingested air, mingled with the bile, makes the bile duct dry, stones unfloated, piled up usually at the sile where the ducts angulated.