套叠瓣在重建胆道中抗反流作用的组织学和细菌学评价

Histological and bacteriological evaluations for antireflux function of intussusceptive valve in reconstructed biliary tract

目的通过观察胆支肠袢套叠瓣成形对胆肠Roux-en-Y吻合术后胆支肠袢组织学和细菌学的影响评价套叠瓣的抗反流效果。方法20只成年家兔按数字随机法分为实验组和对照组，每组10只。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，分别取两组动物胆支肠袢内肠液作细菌培养和菌落计数并对两组胆支肠袢进行组织学分析，细菌学研究结果分别作组间和自身对照t检验分析。结果测得套叠瓣近端胆肠吻合口处（胆侧）和套叠瓣远端肠肠吻合口处（肠侧）肠液菌落数在实验组分别为（2．67±0．39）×10^4／ml和（3．92±1．25）×10^4／ml，在对照组分别为（3．84±0．68）×10^4／ml和（4．06±0．73）×10^4／ml；在组间比较，胆侧肠液菌落计数在实验组少于对照组（P=0．041），而肠侧肠液菌落计数组间差异无统计学意义（P=－1．342）；实验组胆侧肠液菌落计数少于肠侧菌落计数，差异有统计学意义（P=0．032），而对照组差异无统计学意义（P=0．952）。套叠瓣形态良好，仅稍有纤维化和少许炎细胞浸润，两组动物胆支肠袢均存在炎症反应，但以对照组和胆袢肠侧炎细胞浸润较多，而实验组近端胆袢炎症反应轻。结论胆肠Roux-en-Y吻合重建胆道中胆支肠袢套叠瓣成形能减少其近端胆道细菌繁殖和炎症反应，从而能够有效预防术后反流性胆管炎的发生。

Objective To evaluate the antireflux function of intussusceptive valve in Roux-en-Y cholangiojejunostomy reconstructed biliary tract through bacteriohistological methods in biliary intestinal limb. Methods A total of 20 adult rabbits were equally randomized into experimental and control groups. After common bile duct ligation, biliary reconstruction in experimental group was performed by Roux-en-Y cholecystojejunostomy with an intussusceptive valve in biliary intestinal limb while control group underwent Roux-en-Y cholecystojejunostomy alone. Both groups were bred for 3 months after surgery. Then bile bacterial culture and histological study of biliary loop were performed. The data were analyzed with t test for comparing between two groups and self-control. Results Bile colony counts in cholecystojejunostomy and jejunojejunostomy anastomosis were （2. 67± 0. 39） 10^4/ml and （3. 92 ± 1.25） 10^4/ml in experimental group versus （3. 84 ± 0.68） 10^4/ml and （4. 06± 0. 73） 10^4/ml in control group respectively. The count in cholecystojejunostomy anastomosis was less in experimental group than that in control （P = 0. 041）. However, there was no significant inter-group difference in count for jejunojejunostomy anastomosis （P = - 1. 342）. And the colony count at proximal end was less than that at distal end of biliary loop as compared within experimental group （P = 0.032）. However, no significant difference existed in data with control group in corresponding positions （P = 0. 952 ）. The shape of intussusceptive valve in biliary loop was anatomically intact and there were fibrosis and a mild infiltration of inflammatory ceils. There were different degrees of inflammatory reaction in loop tissue. And the infiltration of inflammatory cells was more pronounced in control group and distal end in both groups than that in proximal end of experimental group. Conclusions The intussusceptive valve on reconstructed biliary tract may prevent the refluxant cholangitis effectively through reducing bacteria reproduction and alleviating inflammatory reaction in proximal end of bile loop after Roux-en-Y hepaticojejunostomy.