膵管胆道合流異常における高アミラーゼ血症の発生機序に関する実験的検討

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In cases of cylindrical choledochal dilatation in association with anomalous panereatico-biliary ductal union, the clinical episodes of righ upper quadrant pain, vomiting and fever are recurrently observed. Hyper-amylasemia is seen at each of these episodes, which is generally considered to be caused by acute pancreatitis. However, according to our observations in clinical and experimental studies to date, hyper-amylasemia is supposed to be related to existence of amylase in the biliary system. The purpose of this paper is to prove this relationship through a series of experiments. Twenty-two mongrel dogs underwent laparotomy under intravenous pentobarbital anesthesia. A 14G double lumen tube was inserted into the choledochus. Cystic duct was ligated. The choledochus was inflated with continuous hydrostatic pressure of 20cm H2O for 2 hours. Four groups were designed according to the various concentration of amlase and lipase in the infused fluid. The first contrast group of 5 dogs were infused with 200 ml of lactated Ringer's solution. The second porcine pancreas group of 6 dogs were infused with 40,000 U of amylase from porcine pancreas and 2,000 U of lipase from Rhizopus arrhizus, which were diluted in 200 ra.1 of lactated Ringer's sulution. The third bacillus amylase group of 6 dogs were infused with 120,000 U of amylase from bacillus subtilis and 2,OOO U of lipase from Rhizopus arrhizus, which were diluted in 200ml of lactated Ringers solution. The fourth group of 5 dogs were infused with 20ml of bile juice, containing pancreatic juice, from canine models of anomalous pancreatico-biliary ductal union, which were diluted in 180ml of lactated Ringer's solution. In groups III and IV, hyper-amylasemia were proven in 60 to 120 minutes after the start of infusion with a statistical significance. Moreover, amylase isozyme patterns of porcine pancreas and bacillus subtilis were distinctly different from dog's amylase isozyme pattern. The gradual increase of these foreign isozymes were demonstrated singnificanlty in accordance with infusion. In this way, this experiment proved a possible presence of the direct passage of amylase and lipase through the hepato-choledochal system. This phenomenon has long been exylained as a cholangio-venous reflux.
日本小児外科学会の論文
1983-02-20

膵管胆道合流異常における高アミラーゼ血症の発生機序に関する実験的検討

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