Summary
In an experimental study on 65 rats the influence of different Roux-Y biliary anastomoses on the enterohepatic bile acid circulation was investigated. Long (10 cm) and short (3 cm) isoperistaltic and long (10 cm) anisoperistaltic Roux-Y loops were studied and compared to sham-operated controls. 75-SeHCAT a y-labeled synthetic bile acid was used for assessment of enterohepatic circulation. Hepatic excretion and enteric bile flow was investigated by 99m-Tc-HIDA. Intestinal transit time was evaluated by 51-Cr-EDTA an inert marker of intestinal contents. Animals with biliary anastomoses showed an increased retention of the synthetic bile acid 75-SeHCAT compared to the controls. Highest retention values were found in animals with anisoperistaltic loops (t1/2 = 98.6 h). Isoperistaltic loops showed uniform values indenpendently of the length of the Roux-limb (t1/2 = 59.8 h resp. 59.3 h). Differences to the controls (t1/2 = 42.6 h) were highly significant (p<0.001). In the 99m-Tc-HIDA hepatic excretion into the connected small bowel was normal in all groups. But in rats with biliary anastomoses a marked stasis of the 99m-Tc-HIDA in the Roux-Y loop was apparent. Bowel transit time tested by 51-Cr-EDTA showed comparable results in all groups without significant differences. The results demonstrate an increased bile acid retention in Roux-Y biliary anastomoses. An alteration of the enterohepatic circulation due to stasis in the Roux-Y limb seems to be the underlying mechanism.
Zusammenfassung
In einer experimentellen Studie an 65 Ratten wurde der Einfluß verschiedener biliodigestiver Roux-Y-Anastomosen auf den enterohepatischen Kreislauf der Gallensäuren untersucht. Es kamen lange (10 cm) and kurze (3 cm) isoperistaltische sowie lange (10 cm) anisoperistaltische Roux-Schlingen zur Anwendung, die Ergebnisse wurden mit den Befunden scheinoperierter Kontrolltiere verglichen. Die synthetische Gallensäure 75-SeHCAT diente zur Beurteilung des enterohepatischen Kreislaufs. Der Gallefluß aus der Leber in den Dünndarm wurde mit dem 99m-Tc-HIDA untersucht. Die intestinale Passagezeit wurde nach oral verabreichtem 51-Cr-EDTA verglichen. Tiere mit einer biliodigestiven Roux-Y-Anastomose zeigten im Vergleich zu den Kontrollen eine erhöhte Retention der synthetischen Gallensäure 75-SeHCAT. Die höchsten Retentionswerte wiesen Tiere mit anisoperistaltischen Schlingen auf (t1/2 = 98,6 h). Bei isoperistaltischen Schlingen zeigten sich uniforme Werte unabhängig von der Schlingenlänge (t1/2 = 59,8 h bzw. 59,3 h). Die Unterschiede zu den Kontrollen (t1/2 = 42,6 h) waren hochsignifikant (p<0,001). Die hepatische 99m-Tc-HIDA Ausscheidung war in allen Gruppen normal, Tiere mit einer biliodigestiven Anastomose zeigten jedoch eine ausgeprägte Stase des 99m-Tc-HIDA in der Roux-Y-Schlinge. Die intestinale Passagezeit zeigte im 51-Cr-EDTA Test vergleichbare Ergebnisse in allen Gruppen ohne signifikante Unterschiede. Die Ergebnisse demonstrieren eine erhöhte Gallensäuren-Retention bei biliodigestiven Roux-Y-Anastomosen. Ursächlich scheint dieser Störung des enterohepatischen Kreislaufs eine Stase in der Roux-Y-Schlinge zugrunde zu liegen.
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Arlt, G., Bolder, U., Bares, R. et al. Erhöhte Gallensäurenretention bei biliodigestiven Roux-Y-Anastomosen im Tierexperiment. Langenbecks Arch Chir 375, 283–288 (1990). https://doi.org/10.1007/BF00184169
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DOI: https://doi.org/10.1007/BF00184169