[Clinical and experimental study on reconstruction after pancreatectomy--Part I. Cholangitis and its relationship to reconstruction].
The purpose of the present study is to clarify pathogenesis of cholangitis after pancreatectomy. The clinical study consisted of follow-up survey and hepatobiliary scintigraphy for the patients with type-I reconstruction (e.g. Imanaga procedure) and type-II reconstruction (e.g. Child procedure) after pancreatoduodenectomy. The experimental study was performed in dogs by creating three types of biliary reconstruction, namely, cholecystoduodenostomy (C-D), cholecystojejunostomy (C-J) and Roux-Y cholecystojejunostomy (R-Y). In the follow-up survey, cholangitis occurred in 19.0% of 21 type-I patients and in 33.3% of 18 type-II patients. In the hepatobiliary scintigraphy, type-I demonstrated smooth transit of bile along the reestablishing intestine. Type-II, on the other hand, showed marked stagnation of bile in the excluded loop, which could even trigger cholangitis. The experimental study showed that the results obtained from R-Y were no better than those obtained from C-D and C-J with respect to prevention of cholangitis based on histological, biochemical and bacteriological point of view. These studies suggest that type-I reconstruction carries little risk of causing cholangitis, whereas type-II reconstruction is not effective in preventing cholangitis.
Shiota
M
M
First Department of Surgery, Faculty of Medicine, Kyoto University, Japan.
D000713:Anastomosis, Roux-en-Y; D000818:Animals; D001652:Bile Ducts / Q000000981:diagnostic imaging; D002761:Cholangitis / Q000209:etiology* / Q000517:prevention & control; D002767:Cholecystostomy; D004285:Dogs; D004385:Duodenostomy; D006801:Humans; D007205:Indium Radioisotopes; D008099:Liver / Q000000981:diagnostic imaging; D009942:Organometallic Compounds; D015609:Organotechnetium Compounds; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010193:Pancreaticojejunostomy; D004369:Pentetic Acid; D011730:Pyridoxal / Q000031:analogs & derivatives; D011877:Radionuclide Imaging; D014364:Tryptophan / Q000031:analogs & derivatives
D007205:Indium Radioisotopes; D009942:Organometallic Compounds; D015609:Organotechnetium Compounds; C038081:technetium Tc 99m pyridoxyl-5-methyltryptophan; D011730:Pyridoxal; D004369:Pentetic Acid; D014364:Tryptophan