Summary
A pedicle graft of the jejunum can in some cases enlarge a bile duct stricture. The enlargement of the patch and its consequences on the liver function are possible problems. In an animal experiment the following questions were sought. 1) Is a partial replacement of the bile duct with a pedicle graft of small bowel possible? 2) Is there an enlargement of the patch in every case and what are the consequences on the biliary tract and on liver function. The experiments were performed on 14 minipigs over a long-term observation period of 450 days. The red and white blood cell count, the GPT, GOT, GPT, bilirubin and alkaline phosphatase and copper were checked monthly. After 2, 6 and 12 months the intra- and extrahepatic biliary tract were visualized via a PTC. After 8 months an angiography of the pedicle graft was performed. 15 months later the animals were killed and the bile duct, the graft and the liver were histologically examined. 1) With a pedicle graft of small bowel a partial replacement of the extrahepatic bile duct is possible. 2) An enlargement of the patch is seen in every case. The enlargement is a consequence of tension at the pedicle. After 15 months no morphological changes were observed at the patch nor were there any irregularities in liver function.
Zusammenfassung
Mit einem gestielten Dünndarmpatch konnte in Einzelfällen eine Gallengangsstriktur dauerhaft erweitert werden. Man beobachtet jedoch eine Dilatation des Patches, deren Ursache ebenso wie deren Folgen auf die Leberfunktion bislang ungeklärt sind. Mit einem gestielten Dünndarmpatch ist tierexperimentell ein partieller extrahepatischer Gallengangsersatz möglich. Eine Erweiterung des Patches wird regelmäßig beobachlet. Ursache hierfür ist weder eine Denervation des Patches noch der intraduktale Gallengangsdruck, sondern möglicherweise ein Zug am Gefäßstiel. Morphologische Veränderungen treten am Patch nach bis zu 15 Monaten nicht auf. Leberfunktionsstörungen können weder laborchemisch noch histologisch nachgewiesen werden. Der gestielte Darmpatch stellt daher eine gute Möglichkeit zum partiellen Gallengangsersatz tar. Im Gegensatz zu einer Choledochuszyste scheint die regelmäßig zu beobachtende Dilatation des Patches aufgrund der erhaltenen Kontraktionsfähigkeit nicht zu einer Stase der Galle mit Entwicklung von Cholangitiden oder Konkrementen zu führen. Voraussetzung für these Operationstechnik ist allerdings ein freier Abluß über die Papille.
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Böttger, T., Mann, B., Pickel, B. et al. Tierexperimentelle Untersuchungen zum gestielten Dünndarm-transplantat als partieller extrahepatischer Gallengangsersatz. Langenbecks Arch Chiv 376, 77–84 (1991). https://doi.org/10.1007/BF01263464
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DOI: https://doi.org/10.1007/BF01263464