Canine gallbladder bile. Effects of proximal gastric vagotomy, truncal vagotomy, and truncal vagotomy with pyloroplasty on volume and composition.

Three groups of four dogs each underwent proximal gastric vagotomy, truncal vagotomy, or truncal vagotomy with pyloroplasty. Two dogs had sham operations. Gallbladder bile was aspirated and measured. Aliquots were cultured and assayed for cholesterol, phospholipid, and bile salts initially and at subsequent laparotomies. Both truncal vagotomy groups showed marked increases in aspirate volume at subsequent laparotomies. The sham and proximal gastric vagotomy groups showed a small initial decrease in mean aspirate volume without further significant changes. When the bile assay data were plotted on triangular coordinates, all point for all groups remained well within the area of cholesterol solubility. Nevertheless, two dogs in each truncal vagotomy group were found to have gallstones. No stones were found in the sham and proximal gastric vagotomy groups. Proximal gastric vagotomy appears to preserve fasting gallbladder bile volume and does not alter bile composition in the dog.     

The concentrating function of the feline gallbladder after truncal vagotomy

Truncal vagotomy is associated with a raised incidence of cholesterol gallstone disease and increase in the size of the gallbladder and of the bile acid pool. Investigations of hepatobiliary function in man and mammals after truncal vagotomy have not established if the enlarged gallbladder is simply dilated, or if the absorptive capacity of the mucosa has changed. We studied the concentrating function of the gallbladder with a perfusion technique in anaesthetized cats three weeks and three months after intrathoracic truncal vagotomy and compared the results with a control group. The histology of the gallbladder was studied with light microscopy. Three weeks after vagotomy the gallbladder size, histologic picture and concentrating function did not differ from observations in the control cats. Three months after the vagotomy the gallbladder was slightly enlarged, sludge was found in the luminal contents, an inflammatory response was seen in the mucosa and the net rate of water absorption was increased two to three times compared with the controls. Possible mechanisms in the increased rate of net water absorption are tentatively discussed.     

An electromyographic study on the canine gastric motility following segmental gastrectomy with selective proximal vagotomy

In order to clarify the gastric motility after segmental gastrectomy (SG) with selective proximal vagotomy (SPV), seventeen canines equipped with four bipolar electrodes on the anterior wall of the stomach underwent four types of operation: 1-group, SG (middle corpus) with SPV-6 dogs; 2-group, SG (middle corpus) with SPV and pyloroplasty-5 dogs; 3-group, SG (upper corpus) with SPV-3 dogs; 4-group, SG (middle corpus) with antral vagotomy (AV)-3 dogs. 1-group: In the preanastomosis, the basic electrical rhythm (BER) frequency was not altered significantly, but the propagation velocity of the BER decreased by about 2 to 20% in the late postoperative period. In the postanastomosis, the BER frequency was markedly reduced, but progressively recovered to show the synchronization with that in the preanastomosis following 15 to 30 days postoperation. The propagation velocity of the BER decreased by about 3 to 25% in the late postoperative period. In the postanastomosis, dysrhythmias were observed to occur in high incidence in the early postoperative period, ut were transient occurrence. 2-group: The high-frequency-dysrhythmias (about 10 cycles/min) were observed. Pyloroplasty increased the frequency of dysrhythmias due to deranging the electric insulator of the pyloric ring. 3-group: In the late postoperative period, the BER frequency didn't synchronize with that in the preanastomosis in fasting. 4-group: Dysrhythmias were observed to occur in the late postoperative period. It was suggested that the gastric motility of the SG with SPV recovered in the late postoperative period, therefore pyloric ring can be preserved.     

胃次全切除后圆形吻合器完成残胃-空肠端侧吻合的实验与临床应用研究

目的探讨胃次全切除后采用圆形吻合器行残胃．空肠端侧吻合的实验与临床可行性。方法Beagle＇s犬12条，随机分成A、B两组，在胃窦切除后分别以器械或手工行残胃-十二指肠端侧吻合术。3个月后，以器械行残胃-十二指肠侧侧吻合术。测量残胃十二指肠侧侧吻合处及邻近的十二指肠周长；并观察残胃空肠端侧吻合口直径及愈合情况。选择163例远端胃癌患者，随机分成C、D两组，C组89例，D组74例。胃次全切除后，分别以器械或手工行残胃-空肠端侧吻合术，手术后观察吻合口漏、狭窄等并发症，1年后行稀钡上消化道造影，观察吻合口钡剂通过和2h后残胃钡剂残留情况。结果手术后12条Beagle＇s犬术后均恢复良好，残胃十二指肠侧侧吻合处及邻近的十二指肠周长分别是（6．46±0．06）cm，（7．26±0．12）cm。残胃空肠端侧吻合口及小弯侧三角处愈合均良好，A、B两组吻合口直径分别为（1．18±0．13）cm和（1．20±0．09）cm。两组比较差异无显著性意义（t=0．255，P=0．804）。163例患者均顺利完成手术，术后未出现吻合口漏、狭窄等并发症，术后1年，2组分别行上消化道稀钡造影，均显示吻合口无明显狭窄，钡剂通过顺利，2h后残胃仅见少量钡剂残留。结论胃次全切除后应用器械行残胃-空肠端侧吻合能够在残胃的原位完成消化道重建，降低吻合难度，方法可行。     

胃次全切除后残胃-空肠端侧器械吻合的临床和实验研究

目的 总结胃次全切除后采用弧形切割吻合器行残胃-空肠端侧吻合的临床和实验体会.方法 Beagle犬12条,随机分成A、B两组,在胃窦切除后分别以器械或手工行残胃-十二指肠端侧吻合术;3个月后,以器械行残胃-十二指肠侧侧吻合术;测量残胃十二指肠侧侧吻合处及邻近的十二指肠周长,并观察残胃-空肠端侧吻合口直径及愈合情况.选择145例远端胃癌患者,随机分成A、B两组:A组71例,B组74例.胃次全切除后,分别以器械或手工行残胃-空肠端侧吻合术,手术后观察吻合口瘘、狭窄等并发症;1年后行上消化道造影,观察吻合口钡剂通过和2 h后残胃钡剂残留情况.结果 12条Beagle犬术后均恢复良好,残胃十二指肠侧侧吻合处及邻近的十二指肠周长分别是(6.46±0.06)cm和(7.26±0.12)am;残胃空肠端侧吻合口及小弯侧三角处愈合均良好,A、B两组吻合口直径分别为(1.18±0.13)cm和(1.20±0.09)cm;两组比较差异无统计学意义(t=0.255,P=0.804).145例患者均顺利完成手术,术后未出现吻合口瘘、狭窄等并发症;术后1年,两组分别行上消化道稀钡造影,均显示吻合口无明显狭窄,钡剂通过顺利,2 h后残胃仅见少量钡剂残留.结论 胃次全切除后应用器械行残胃-空肠端侧吻合能够在残胃的原位完成消化道重建,降低吻合难度,确保足够的胃切除,避免撕裂脾脏和脾周血管.     

The effect of vagotomy on gallbladder function and bile composition in man.

Vagotomy and gastric surgery have been implicated in gallstone formation, although the association remained unproven. Gallbladder function was investigated in 11 patients with a pyloroplasty and truncal vagotomy, 5 with a subtotal gastrectomy, and 16 healthy controls. Gallbladder filing and emptying in response to cholecystokinin (CCK 0.01 U/kg min), when quantitated by 99m-Tc-HIDA cholescintigraphy, did not show any differences between the control and the surgical groups. In each group, over 70% of hepatic activity partitioned into the gallbladder rather than the duodenum, filing the gallbladder at 2.1%/min. Gallbladder emptying began five minutes after initiating the CCK infusion and ejected half of its contents during the next 12 minutes. Biliary lipid compositions was determined in 20 patients who underwent elective pyloroplasty and vagotomy for duodenal ulcer disease. Gallbladder bile collected at surgery was compared to bile-rich duodenal fluid aspirated eight months after recovery from surgery. Cholesterol saturation decreased significantly (p less than 0.05) both in terms of the relative cholesterol content (6.9% leads to 5.2%) and the lithogenic index (1.24 leads to 0.84). To determine if a selective increase in one of the conjugated bile salts could explain this improvement, bile salt composition was analyzed by high pressure liquid chromatography in eight patients and showed no change after surgery. Thus, vagotomy does not adversely affect gallbladder function, but instead improves cholesterol solubility.     

远端胃大部分切除后 Roux-en-Y消化道重建术对小肠排空影响的实验研究

目的 探讨胃大部切除Ｒｏｕｘ－ｅｎ－Ｙ胃空肠吻合术后小肠的排空功能。方法 本实验应用放射性素得标记试餐的方法,研究ＳＤ鼠胃部分切除Ｂ ｉｌｌｒｏｔｈ－１,Ｒｏｕｘ－ｅｎ－Ｙ及Ｒｏｕｘ－ｅｎ－Ｙ式吻合附加迷走神经干切中胃肠道重建术式的胃肠排空状态。结果 各组胃肠放射活性分布显示：假手术,Ｂｉｌｌｒｏｔｈ－１及Ｒｏｕｘ－ｅｎ－Ｙ吻合术式的胃肠道放射性呈双峰分布,其中第二放射峰,假手术位于中段小肠,Ｂｉ     

Bile reflux and degree of gastritis after highly selective vagotomy,truncal vagotomy,and partial gastrectomy for duodenal ulcer

World Journal of Surgery - Enterogastric reflux of bile has been shown to be associated with chronic gastritis. We have investigated preoperative duodenal ulcer patients and patients treated by...     

A gallbladder flap for reconstruction of the common bile duct. An experimental study on pigs

Background/Purpose In this article we investigate whether a gallbladder flap could be used for reconstruction of the common bile duct (CBD), thereby providing drainage via an intact sphincter of Oddi.Methods Eight LWD pigs were used for the experiments. The gallbladder was dissected from its fossa, care being taken not to damage its vessels. The CBD was then displayed and approximately 5mm resected. In two pigs a tube, and in six pigs a sphere, was constructed from the gallbladder falp. Anastomoses wre constructed between the gallbladder flap and the CBD. Blood samples were drawn and on day 10 a laparotomy and an intraoperative cholangiography was performed.Results No pigs showed any sign of biliary leakage and standard liver parameters were not affected by surgery. In the two pigs who had a tube constructed, cholangiography showed extrahepatic stenosis and intrahepatic biliary dilatation. In the six pigs who had a sphere constructed, cholangiography was without any sign of extrahepatic stenosis or intrahepatic dilatation.Conclusion Reconstruction of the CBD by way of a gallbladder flap seems to be a safe procedure to accomplish biliary drainage. This procedure could be of clinical significance for reconstruction of the CBD after resections for benign strictures and tumors, and for reconstruction after blunt or penetrating trauma.     

An experimental study on the effect of vagotomy on stress ulcer and the influence of bile reflux

I investigated the significance of bile reflux, when vagotomy was done to stress ulcer, by means of measuring gastric ulcer index, gastric pH and serum gastrin levels of rats. And in order to examine influence of alkali factor of bile, I measured gastric acid output and serum gastrin levels after alkali or acid solution was infused into the untreated rat's stomach. Results were summarized as follows: 1. When I infused alkali solution into the untreated stomach, there was no significant change in serum gastrin level but gastric acid output was significantly accelerated, as compared with infusing acid solution. On the other hand, when I infused alkali solution into the vagotomized stomach, serum gastrin level increased significantly and gastric acid output was significantly accelerated, as compared with infusing acid solution, so, acceleration of acid output observed when I infused alkali solution into the untreated stomach was not suppressed in spite of vagotomy operation. 2. In the vagotomized group, gastric acid output was significantly suppressed and serum gastrin level increased significantly as compared with the untreated group. But, when bile was led into the stomach in the vagotomized group, acid output was accelerated and serum gastrin level also showed a tendency to increase as compared with the group of vagotomy alone. 3. When mild stress was inflicted, stress ulcer formation was significantly prevented in the bile reflux group (vagotomy + pyloroplasty) as well as in the non-bile reflux group (vagotomy + pyloric ligation + gastroileostomy) if vagotomy was done. But, when severe stress was inflicted, stress ulcer formation was significantly prevented in the non-bile reflux group, but not prevented in the bile reflux group. As mentioned above, it was proved that stress ulcer formation was not prevented under a severe stress, if bile reflux existed, even though vagotomy was done. So, if we do vagotomy operation, we need to choose the operation method not to induce bile reflux as much as possible.     

Wound infection after cholecystectomy. Correlation between bacteria in bile and wound infection after operation on the gallbladder for acute and chronic gallstone disease.

OBJECTIVE: To see if there was a difference in the wound infection rates after operation for acute and chronic cholecystitis, and to see if the presence of bacteria in the bile had any influence on those rates. DESIGN: Prospective open study. SETTING: University hospital. SUBJECTS: 213 Patients undergoing cholecystectomy for acute or chronic gallstone disease. MAIN OUTCOME MEASURES: Incidence of postoperative wound infection, and of bile cultures growing pathogenic organism. RESULTS: There was no difference in wound infection rates between patients operated on for acute and those operated on for chronic cholecystitis. The presence of bacteria in the bile did not seem to influence the wound infection rate in either group. CONCLUSIONS: Early cholecystectomy and appropriate antibiotic prophylaxis result in an acceptably low wound infection rate, and the growth of bacteria from bile is not predictive of the development of wound infection.     

胃毕Ⅱ式术后患者肝内外胆管结石的腹腔镜及胆道镜治疗

目的探讨胃毕Ⅱ式术后肝内外胆管结石的腹腔镜及胆道镜治疗。方法对78例胃毕Ⅱ式术后的患者进行腹腔镜胆囊切除32例,其中胆囊切除 胆总管切开取石 胆总管一期缝合12例;胆囊切除 胆总管切开取石 T管引流22例;胆囊切除 胆总管切开取石T管引流 胆总管十二指肠吻合术6例;胆总管切开取石T管引流 左肝外叶切除6例。结果除4例中转开腹外,74例获成功。内镜及腹腔镜术治疗无严重并发症。手术时间为90～240(平均135)min,住院天数4～12(平均9.3)d,术中出血50～400(平均95)ml。随访14～22个月,平均19.4个月,无结石复发。结论胃毕Ⅱ式术后肝内外胆管结石者施行腹腔镜及胆道镜治疗成功率较高,具有微创、住院时间短、恢复快等优点。     

胆囊结石患者合并胆总管结石预测模型的研究

目的对胆囊结石患者常规应用磁共振胆胰管成像（magnetic resonance cholangiopancreatography,MRCP）以诊断胆总管结石的必要性进行探讨,并研究Logistic回归预测模型结合MRCP诊断胆总管结石的有效性。方法对常规接受术前MRCP检查的1 030例胆囊结石患者进行回顾性研究（对照组）;并对366例首次入院的胆囊结石患者进行前瞻性研究（研究组）。结果对照组胆总管结石阳性率为7.8%（80/1 030）,假阳性率为0%（0/80）,假阴性率为0.4%（4/950）。根据5项指标：B超发现胆总管扩张或胆总管结石、年龄大于65岁、发热、血清碱性磷酸酶〉121 IU/L、血清淀粉酶〉100 U/L,可预测胆总管结石存在的可能性。预测模型的筛选阈值为6%（P〈0.05）。根据筛选值是否高于标准阈值而决定研究组患者是否接受MRCP检查。仅1例手术后发生腹痛并经进一步检查后诊断为胆总管结石（1/174）。研究组与对照组患者相比较,MRCP阳性率明显提高、住院时间明显缩短、住院费用明显降低（P〈0.01）。结论低于预测模型的筛选阈值的患者并无行MRCP的必要性。应用本研究指出的预测模型结合MRCP可显著降低患者治疗费用、缩短住院时间,同时并不增加临床漏诊胆总管结石的几率。