膽道減壓術後 吻合口 口徑의 變化에 대한 實驗的 硏究 = The Sizes of Anastomotic Stomata after Various Types of Biliary Decompression

다국어 초록 (Multilingual Abstract)

Many procedures for surgical decompression of biliary tract using intestinal loop have been reported. Prevention of stenosis of the anastomotic stoma is especially important in the view of longterm results. Author performed cholecystojejunostomy in 4 dongs, choledochoduodenostomy in 3 dogs and choledochojejunostomy in 3 dogs 10 days after complete ligation of common bile duct, leaving gall bladder intact. Changes of hematologic values, liver function test, regurgitation of intestinal contents, changes of anastomotic stomal size at biliary decompression operation and then 6 months later, gross and histopathologic findings of liver, spleen, anastomotic site and brain at autopsy were observed in cholecystojejunostomy, choledochoduodenostomy and choledochojejunostomy groups.
Followings were the results obtained:
1. There were no remarkable hematologic changes except leukocytosis in the group of ligated common bile duct and biliary-intestinal anastomosis comparing with control group.
2. In liver function tests, total protein and A/G ratio were within normal limits but total cholesterol, alkaline phosphatase, SGOT, SGPT, total bilirubin and thymol turbidity were remarkably increased in the group of ligated common bile duct and were slightly decreased 1 week after biliary decompression operation. SGOT, SGPT, total bilirubin and thymol turbidity were decreased to near normal within 24 weeks after each decompression. Total cholesterol and alkaline phosphatase, however, were only slightly decreased in 6 months after the decompression procedure.
3. Reflux of the intestinal contents into biliary tract observed in 4 out of 6 dogs.
4. Anastomotic stoma were more remarkably stenosed in the group of cholecystojejunostomy 6 months after decompression operation, the size of anastomotic stoma was 1.5㎝ at operation and 0.3-1.2㎝ at autopsy. In choledochoduodenostomy the size of anastomotic stoma was 1.5㎝ at operation and 1.2㎝ at autopsy 6 months after operation. In choledochojejunostomy the size of anastomotic stoma was 2.0㎝ at operation and 1.5㎝ at autopsy 4 weeks after the procedure.
5. Ascending infection was more evident in 2 cases of cholecystojejunostomy in 24 weeks and those in others were mild.
6. At autopsy gross findings of liver, spleen and brain were relatively normal except the hepatomegaly in 1 case.
7. In the group of cholecystojejunostomy, significant pathologic findings of liver were degeneration of hepatic cell, disarray of cell cord, venous congestion, portal fibrosis, portal infiltration and bile duct proliferation. Pathologic changes of spleen of significance were sinus congestion, hemorrhage, atrophy of white pulp, hemosiderin pigmentation and trabecular hypertrophy. Hemorrhage, fibrosis, foreign body granuloma, mucosal ulcer and lymphocytic infiltration were observed at anastomotic sites. Above changes were relatively mild to moderate in choledochoduodenostomy and choledochojejunostomy groups.
8. Large abnormal astrocytes in brain tissue were moderately increased in number 2 cases of cholecystojejunostomy and in 1 case of choledochojejunostomy.

목차 (Table of Contents)

• Ⅰ. 緖論
• Ⅱ. 實驗材料 및 方法
• A. 實驗材料
• B. 手術方法
• C. 血液, 組織採取方法 및 各種檢査方法
• Ⅲ. 實驗成績
• A. 血液像
• B. 肝機能檢査
• C. 吻合口의 크기의 變化와 場內容物의 逆流現象
• D. 肝, 脾臟, 吻合部 및 腦의 病理組織學的 所見
• 1. 肉眼的 所見
• 2. 顯微鏡 所見
• a. 膽囊空腸吻合術群
• b. 總輸膽管十二指腸吻合術群
• c. 總輸膽管空腸吻合術群
• Ⅳ. 總括 및 考按
• Ⅴ. 結論
• 參考文獻
• 寫眞附圖