Experimental study on operative methods of pancreaticojejunostomy with reference to anastomotic patency and postoperative pancreatic exocrine function

AIM:To assess the patency of pancreaticoenterostomy and pancreatic exocrine function after three surgical methods. METHODS: A pig model of pancreatic ductal dilation was made by ligating the main pancreatic duct. After 4 wk ligation, a total of 36 piglets were divided randomly into four groups. The piglets in the control group underwent laparotomy only; the others were treated by three anastomoses: (1) end-to-end pancreaticojejunostomy invagination (EEPJ); (2) end-to-side duct-to- mucosa sutured anastomosis (ESPJ); or (3) binding pancreaticojejunostomy (BPJ). Anastomotic patency was assessed after 8 wk by body weight gain, intrapancreatic ductal pressure, pancreatic exocrine function secretin test, pancreatography, and macroscopic and histologic features of the anastomotic site. RESULTS: The EEPJ group had significantly slower weight gain than the ESPJ and BPJ groups on postoperative weeks 6 and 8 (P < 0.05). The animals in both the ESPJ and BPJ groups had a similar body weight gain.Intrapancreatic ductal pressure was similar in ESPJ and BPJ. However, pressure in EEPJ was significantly higher than that in ESPJ and BPJ (P < 0.05). All three functional parameters, the secretory volume, the flow rate of pancreatic juice, and bicarbonate concentration, were significantly higher in ESPJ and BPJ as compared to EEPJ (P < 0.05). However, the three parameters were similar in ESPJ and BPJ. Pancreatography performed after EEPJ revealed dilation and meandering of the main pancreatic duct, and the anastomotic site exhibited a variable degree of occlusion, and even blockage. Pancreatography of ESPJ and BPJ, however, showed normal ductal patency. Histopathology showed that the intestinal mucosa had fused with that of the pancreatic duct, with a gradual and continuous change from one to the other. For EEPJ, the portion of the pancreatic stump protruding into the jejunal lumen was largely replaced by cicatricial fibrous tissue. CONCLUSION: A mucosa-to-mucosa pancreatico- jejunostomy is the best choice for anastomotic patency when compared with EEPJ. BPJ can effectively maintain anastomotic patency and preserve pancreatic exocrine function as well as ESPJ.

Observation effect of clinical ursodeoxycholic acid combined with holmium laser by laparoscopic choledochoscopy in the treatment of intrahepatic and intrahepatic bile duct stones

Objective: To investigate the effect of clinical ursodeoxycholic acid combined with holmium laser by laparoscopic choledochoscopy in the treatment of intrahepatic and intrahepatic bile duct stones. Methods: Patients with intrahepatic and intrahepatic bile duct stones treated by surgery in our hospital from October 2017 to December 2018 were randomly divided into control group and observation group.Patients in the control group were treated with laparoscopic choledochoscopy combined with holmium laser lithotripsy, and patients of the observation group were treated with ursodeoxycholic acid on the basis of the control group. The clinical efficacy, total bile acid (TBA), phospholipid (PLIP), cholesterol (CHO) levels and the incidence of complications of liver function and bile related indicators were compared between the two groups after 3 and 6 months treatment. Results: After 3 months treatment, there were 22 cases of cured patients, 11 cases of markedly effective and 5 cases of effective patients in the observation group of, which he clinical curative effect was significantly better than that of control group (P<0.05). After 3 months and 6 months treatment, AST, ALT, TBil, CHO levels in two groups were decreased compared with that before treatment, and TBA, PLIP levels were increased. The liver function of patientsin the observation group was obviously better than that in the control group with the statistical significance difference (P<0.05). However, the symptoms such as the right upper quadrant pain, jaundice, chills, fever in the observation group was significantly improvedthan that of the control group. The incidence of complications including nausea and vomiting, fatiguewas 4.76%, significantly lower than that 19.05% in the control group (P<0.05). After 1 year follow-up, it was found that recurrence reoperation rate of observation group was significantly lower than that the control group. The difference was statistically significant (P<0.05). Conclusion: Theclinical curative effect of the ursodeoxycholic acid combined with holmium laser by laparoscopic choledochoscopy was distinct, whichcould effectively improve the undesirable complications, reduce the postoperative recurrence and reoperation rate. The main reason may be the combination therapy could improve the patients' associates, PLIP level, lower levels of AST, ALT, TB il and CHO, which helped to improve liver function, reduce the cholestasis, prevent the recurrence of liver and gallbladder stones, and promote good prognosis.