套叠瓣在重建胆道中抗反流作用机制研究  

Antireflux mechanism of intussusception valve in reconstructed biliary tract

作　　者：鞠春慧[1,2] 吴学东[1,2] 李庄[1,2] 李乐生[1,2] 李爱民[1,2] 杨利杰[1,2] 

机构地区：[1]大理学院附属医院 [2]大理学院临床医学研究中心小儿外科,云南大理671000

出　　处：《中国普通外科杂志》2012年第2期169-172,共4页China Journal of General Surgery

摘　　要：目的:探讨胆支肠袢套叠瓣成形在胆肠Roux-en-Y吻合重建胆道术后的抗反流机制。方法:20只成年家兔随机均分为实验组和对照组。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,测量两组胆道顺流压和逆流压,并在测压同时给予造影。结果:胆道顺流压实验组为(5.91±1.46)cmH2O(1 cmH2O=0.098 kPa),对照组为(4.82±0.39)cmH2O;逆流压实验组为(14.32±1.67)cmH2O,对照组为(4.90±0.37)cmH2O。统计分析显示,两组间顺流压的差异无统计学意义(P>0.05),但逆流压实验组明显大于对照组(P<0.01);实验组逆流压明显大于自身顺流压(P<0.01),而对照组两者间差异无统计学意义(P>0.05)。造影结果显示,套叠瓣能阻止造影剂进入其上方胆支肠袢。结论:胆肠Roux-en-Y吻合重建胆道术后胆支肠袢套叠瓣通过增加Y袢胆臂逆流压而发挥抗反流作用。Objective： To investigate the mechanism of the antireflux action of intussusception valve constructed in the biliary intestinal limb of Roux-en-Y cholecystojejunostomy after biliary tract surgery. Methods： Twenty adult rabbits were equally randomized into the experimental group and control group. After common bile duct ligation, the biliary reconstruction in the experimental group was performed using Roux- en-Y cholecystojejunostomy with an intussusception valve created in the biliary intestinal limb, while theprocedure in the control group was Roux-en-Y cholecystojejunostomy alone. Rabbits of the two groups were bred 3 months after surgery, and then their isoperistaltic pressure （IPP） and antiperistaltic pressure （APP） in the reconstructed biliary tract was measured, meanwhile a contrast X-ray examination was also performed. Results： The IPP values of the experimental group and control group were （5.91±1.46） cmH2O （1 cm H2O=0.098 kPa） and （4.82±0.39） cmH2O, and the APP values of them were （14.32±1.67） cmH2O and（4.90±0.37） cmH2O, respectively. Statistical analysis indicated that the APP value of experimental group was significantly higher than that of control group （P〈0.01）, but the IPP values between the two groups had nostatistical difference （P〉0.05）; the APP values were significantly higher than the IPP values in experimental group （P〈0.01）, but the two values showed no statistical difference in control group （P〉0.05）. Contrastexamination showed that the intussusception antireflux valve in the biliary limb of the small bowel could restrict the entering of contrast material into its upper segment. Conclusion： Intussusception valve exerts effective action against reflux in the biliary tract reconstructed with Roux-en-Y biliary-enteric anastamosis through increasing APP of the biliary limb of the Y structure.

关 键 词：吻合术 ROUX-EN-Y 胆道外科手术 套叠瓣 抗反流 动物实验 

分 类 号：R657.4[医药卫生—外科学]