胆道内圧に関する臨床的ならびに実験的研究 : 特に胆道末端部病態、胆道感染時血中endotoxinなどとの相関
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概要
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In surgical treatment of benign bile duct diseases, especially in treating biliary stones, assessment of function of the sphincter of Oddi becomes crucial. For this purpose the pressure of the common bile duct during operation and 5-11 days after operation was measured using a kind of "constant flow rate perfusion method" in 33 patients with biliary stones and in two with congenital cystic dilatation of the choledochus (CCDC) . Along with these clinical studies, a series of experimental studies on biliary pressure were performed in mongrel dogs utilizing the same technic with smaller flow rates. Moreover, the influence of infected bile on bile duct pressure and the relation between the pressure of infected bile and endotoxemia were investigated. The results were as follows. The patterns of biliary pressure curve could roughly be classified into three types; "normal", "obstructive" and "intermediate". "Normal" type was obtained from patients with gall bladder stones, a part of choledocholithiasis patients and postoperative cases. These cases could be considered to have normally-functioning Oddis. "Obstructive" type was observed in patients with obstructive chledocholithiasis and in a case with CCDC. "Intermediate" was observed in patients with fewer problems around Oddi than "Obstructive" cases. Perfusion pressures were generally lower in gall bladder stone cases compared with those in common duct stone cases. Relation between flow rate and perfusion pressure was generally not linear but curvilinear, and when flow rate is plotted along horizontal axis and perfusion pressure along vertical axis, the "normal" type group generally displayed positive convex curves, and on the other hand, "intermediate" type group developed by and large positive concave curves. For analysing these curves, a coefficient (R) was calculated defining R = △ perfusion pressure/△ flow rate, which was considered to represent the resistance of the sphincter of Oddi against biliary flow. These R values were significantly larger in cases of common bile duct stones with possible Oddi's stenosis and they were smaller in gall bladder stone cases which were estimated to have normally-functioning Oddis. All dogs undergoing saline perfusion showed "normal" perfusion patterns. Relations between flow rate and perfusion pressure were generally convex curvilinear. When dogs were perfused with infected bile, perfusion pressures were often elevated compared with saline perfusion, and intermittent spasmodic elevation of the pressure sometimes occured. The relation between the pressure of the infected bile in the choledochus and endotoxemia was that, the higher the pressure, the higher the incidence of endotoxemia. This tendency was marked especially when the pressure exceeded 25 cm H_2O. From these findings, the author wishes to insist the importance of assessing biliary pressure for bile duct operations.
- 神戸大学の論文