Experimental Study of Ascending Cholangitis after Biliary Reconstruction with Neuro-lymphatic Dissection around the Superior Mesenteric Artery

This study is investigated not only the pathogenesis of ascending cholangitis after biliary reconstruction but also the relation between ascending cholangitis and neuro-lymphatic dissection around the superior mesenteric artery(SMA). We evaluated three types of biliary reconstruction, namely, cholecystoduodenostomy(D group), Roux-en Y cholecystojejunostomy(R group), and jejunal interposition cholecystoduodenostomy(I group), which were randomly performed in dogs with no(N group), right semicircular(S group), or total circular (T group) lymphatic dissection around the root of SMA. Results showed significant increase in the deconjugation and dehydroxylation ratio of bile acids, and in bacterial flora of the upper jejunum which was used for reconstruction. The histological examination of liver tissue indicated the existance of mild or moderate ascending cholangitis in all models. The decrease in primary bile acids and the increase in secondary bile acids in the D group were significant lower than those in the R group or the I group. On liver histopathology, the grade of ascending cholangitis showed a tendency to be the mildest in the D group and the most severe in the I group. The present study demonstrated that there were no significant differences among the N group, the S group, or the T group on any examination and that the occurrence of ascending cholangitis was not directly influenced by the extent of neuro-lymphatic dissection around the SMA.

上行性胆菅炎

胆道再建

上腸間膜動脈根部郭清

腸菅内胆汁酸

腸菅内細菌