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KMID : 0438219740110021271
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Korea University Medical Journal
1974 Volume.11 No. 2 p.1271 ~ p.1319
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Experimental Study on Various Biliary Decompression
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Abstract
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As one of researches on biliary tract, authors at the department of general surgery performed 13 kinds of biliary decompression. 1. cholecysto-jejunostomy, 2. cholecystojejunostomy with enteroenterostomy, 3. cholecysto-jejunostomy Roux-en-Y, 4. cholecystoduodenostomy, 5. cholecystogastrostomy, 6. choledochoduodenostomy, 7. choledochojejunostomy, 8. choledochojejunostomy with enteroenterostomy, 9. choledochojejunostomy, Roux-en-Y 10. choledochoduodenostomy and cholecystectomy, 11. choledochojejunostomy and cholecystectomy, 12. choledochojejunostomy with enteroenterostomy and cholecystectomy, 13. choledochojejunostomy Roux-en-Y and cholecystectomy in 105 mongoreal adult dogs in 10 days after complete ligation of common bile duct.
Changes of hematologic values, liver function tests, and histopatholoogical findings of hepatobiliary system were observed in normal group, and these results were further observed on the 10th day after common bile duct-ligation and on the 42 nd day after biliary decompression. Bacteriological findings of bile, changes of the size of an anastomotic stoma, and biliary-intestinal reflux were observed on the 42 nd day after biliary decompression.
The results obtained are as follows:
1. Changes of hematologic values
There were leukocytosis in the groups of common bile duct-ligation and 13 kinds of biliary decompression. Hemoglobin was decreased after common bile duct ligation and returned to normal level in 42 days after biliary decompression. There were no remarkable changes in R. B. C. and hematocrit.
2. Liver function test
In liver function test, total,protein in serum was slightly decreased in the ligated common bile duct group and common bile duct-ligation and cholecystectomy group compared with the control group, but returned to normal level in 42 days after biliary decompression. A/G ratio was more slightly decreased in the common bile duct-ligation group than in the common bile duct-ligation and cholecystectomy group. It returned to normal level in 42 days after biliary decompression, but the grade_of recovery was .delayed in choledocho-enterostomy and cholecystectomy group. -Compared with
control group, the ligated common bile duct group and the common bile duct-ligation and cholecy stectomy group revealed a remarkable increment of alkaline phosphatase in 10days after common bile duct ligation; the increment was more remarkable in the common bile duct-ligation and cholecystectomy group. It returned to normal level in 42 days after biliary decompression, but the grade of recovery was delayed in choledochoenterostomy and cholecystomy group. Total cholesterol in serum was more increased in the common bile duct-ligation and cholecystectomy group than in the common bile duct ligation group, but in 42 days after biliary decompression the two groups returned to normal level similarly. S-GOT was commonly increased in the common bile duct ligation group and the common bile duct-ligation and cholecystectomy group. On the 42 nd day after biliary decompression it returned to normal level, but the grade of recovery was delayed in choledochoente rostomy and cholecystectomy group. S-GPT was higher in the common bile duct-ligation and cholecystectomy group than in the common bile duct-ligation group, but in 42 days after biliary decompression the former group returned to normal level more rapidly than the latter. Thymol turbidity and the total bilirubin were higher in the common bile duct-ligation and cholecystectomy group than in the common bile duct-ligation group, but in 42 days after biliary decompression the two groups returned to normal level similarly.
3. Bacteriological findings of bile
On the 42nd day after biliary decompression in the direct smear of bile, bacteira were demonstrated throughout the whole groupF, but somewhat less in the biliary decompressed group operated after common bile duct-ligatior_ and cholecystectomy. Gram negative bacilli were mostly. In bacterial culture, bacteria were demonstrated in all groups, where E. Coli, enterococcus, and Proteus species were seen.
4. Changes of the size of an anastomotic stoma
On the 42nd day after biliary decompression in all groups, the size of anastomotic stomas was decreased by the range from 25.9% to 50%.
5. Biliary-intestinal reflux
On the 42nd day after biliary decompression, the biliary-intestinal reflux was more remarkabley revealed in cholecystogastroenterostomy group than other groups and the slightest in choledochoenterostomy and cholecystectomy group. Comparing with each biliary decompressed group, the authors observed the slightest reflux in choledochoduodenostomy group and choledochojejunostomy Roux-en-Y group and choledochojejunostomy Roux-en-Y and cholecystectomy group; the result was the best in choledochojejunostomy Roux-en-Y and cholecystectomy group among them.
6. Histopathological findings of hepato-biliary system
In the common bile duct-ligation group, bile-pigmented granules in Kupffer´s cells and hepatic cells (more remarkable in Kupffer´s cells), bile plugs in canaliculi, and centrilobular bile stasis were moderate; decreased glycogen amount, ductular dilatation, and ductular proliferation were moderate; centrilobular necrosis was slight; dilatation of central veins and sinusoids and Kupffer´s cell mobilication were slight; increase and thickening of collagen fibers in amount and lymphocytic, histiocytic, and neutrophilic infiltration were severe. In the common bile duct-ligation and cholecystectomy group, the histopathological findings revealed similar result with the former except that the bile plugs in canaliculi and centrilobular bile stasis were more severe; the ductular dilatation and proliferation were more severe; the centrilobular necrosis was moderate;. Kupffer´s cell mobilization was moderate. In general, the histopathological findings on the 42nd day after biliary decompression revealed more remarkable recovery to normal level in the 13 groups of biliary decompression than in the common
bile duct-ligation group either with or without cholecystectomy. And though bile pigmented granules, bile stasis, ductular dilatation and proliferation, decreased glycogen amount, necrosis of hepatic cell, dilatation of central vein and sinusoids, and the inflammatory reaction were slightly demonstrated in the 13 groups of biliary decompression. they returned to normal level remarkably. There were not any significant differences among the three divisions of 13 biliary decompression groups-A. Cholecystogastrostomy group (gall bladder in situ), B. Choledochoenterostomy group (gall bladder in situ), C. Choledochoenterostomy and cholecystectomy group, but the groups of gall bladder in situ returned to normal somewhat slowly with respect to the inflammatory reactions and hepatic cell alteration. Especially in choledochoduodenostomy and choledochojejunostomy Roux-en-Y group revealed excellent grade of recovery, on which biliary decompression was operated after common bile duct-ligation and cholecystectomy.
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