犬肝管胆囊吻合和肝管空肠吻合术后胆汁成分变化的对比

The comparison of the changes of bile components in dogs with hepaticocholedochostomy vs hepaticojejunostomy

目的 探讨犬肝管胆囊吻合和肝管空肠吻合术后胆汁成分的不同变化。方法 2 9条犬被随机分为对照组 (5条 )和不全梗阻模型组 (2 4条 )分别实施假手术和左肝管不全梗阻 ,不全梗阻 7周后平均随机分为胆囊胆管吻合术 (HC组 ,12条 )和空肠胆管吻合术 (HJ组 ,12条 ) ,分别实施HC和HJ ,术中及术后 1个和 5个月分别引流胆管胆汁 ,进行成分 [胆汁酸 (TAB)、未结合胆红素(UCB)、钙离子、总胆红素 (TB)、胆固醇 (Ch)、磷脂 (PL)等 ]检测。结果 术后 1个和 5个月时 ,吻合口上方胆汁中总胆汁酸、胆固醇、总胆红素、磷脂浓度HC组均显著性高于同期HJ组 ,而游离胆红素、钙离子两组间差异均无显著性 ;术后 5个月时 ,HC组Ca2 + ,UCB/TAB比值为 0 .0 8± 0 .0 1,显著性低于HJ组的 0 .2 3± 0 .0 7。结论 与HJ相比 ,HC术后肝管胆汁成分更有利于减少结石发生。

Objective To study the changes of bile components in dogs with hepaticocholedochostomy vs hepaticojejunostomy.Methods Twenty-nine dogs were divided randomly into two groups: control group (5 dogs) and model (stenosis of left hepatic duct) group (24 dogs).The 24 dogs in model group were divided randomly into 4 subgroups: 1 month after hepaticocholedochostomy (HC) group (5 dogs),5 month after HC group (6 dogs),1 month after hepaticojejunostomy (HJ) group (5 dogs) and 5 month after HJ group (4 dogs).At the end of the experiment,the bile was withdrawn from the bile duct.The bile components were measured,such as total bile acid,total bilirubin,unconjugated bilirubin,Ca 2+,cholesterol,phospholipids.Results On the first month and 5th month postoperatively,the concentrations of total bile acid,cholesterol,total bilirubin and phospholipids of dog's bile at left hepatic duct in HC group were higher than those in HJ group,while the concentrations of Ca 2+ and unconjugated bilirubin had no significant difference between the two groups.On the 5th month postoperatively,The ratio of Ca 2+.UCB/TAB in HC group was 0.08± 0.01,which was significantly lower than 0.23± 0.07 in HJ group.The concentrations of total bile acid,cholesterol and total bilirubin on the 5th month postoperatively were higher than those on the first month postoperatively.The concentrations of each bile component in dogs receiving hepaticojejunostomy had no significant difference between 5 month and 1 month postoperatively.Conclusion The changes of bile components of dogs undergoing hepaticocholedochostomy had more advantages of preventing pigment stone than that of dogs undergoing hepaticojejunostomy.