AN EXPERIMENTAL STUDY ON TRANSDUODENAL SPHINCTEROPLASTY
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概要
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To estimate the decompression effect and the degree of elimination of constricting mechanism of the sphincter of Oddi in transduodenal sphincteroplasty, the present study was carried out using eighty rabbits.<BR>After wedge-resection of the sphincter Oddi was made longitudinally in half of itslength (5-6 mm) or whole through transduodenal approach, biliary pressure, intraduodenal pressure, terminal choledochal pressure, and electrical activity of the Oddi's muscle were studied.<BR>The results were summarized as follows;<BR>1) At fast and rest, the biliary pressure and the intraduodenal pressure were 61.8±8.8 mmH<SUB>2</SUB>O and 23.4±3.3 mmH<SUB>2</SUB>O respectively showing a pressure gradient of 40 mmH<SUB>2</SUB>O approximately. Terminal choledochal pressure gave 81.6±12.9 mmH<SUB>2</SUB>O superimposed on by a 3.6±0.3 cycles/min contraction of Oddi's muscle in its pressure curve.<BR>2) In 50% sphincter-resected group, biliary pressure resulted in a slight of 7.7±4.2% and that of terminal choledochal pressure 21.3±6.7%. Occurrence of Oddi's contraction also decreased to 2.4±0.3 cycles/min.<BR>3) In 100% sphincter-resected group, biliary and terminal choledochal pressure decreased markedly giving a value of 30.1±6.6% and 40.8±8.0% respectively. Oddi's contraction disappeared completely in all cases and the gradient maintained between the biliary and intraduodenal pressure was only about 20 mmH<SUB>2</SUB>O.<BR>4) By administration of morphine a pressure rise was found by about 20% in 50% sphincter-resected group, whereas no pressure change was observed in 100% sphincter-resected group.<BR>5) In the electrical activity of the sphincter of Oddi, the spike discharge observed preoperatively was totally disappeared and no response was found even in administration of neostigmin.<BR>The results indicate that sphincterotomy or incomplete sphincteroplasty is not a surgical operation satisfactory for biliary drainage or decompression.<BR>On the contrary it appears that complete sphincteroplasty is an effective means for decompression and destruction of sphincteric mechanism of the muscle of Oddi.
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