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Chirurgia 2018 August;31(4):139-42

DOI: 10.23736/S0394-9508.17.04731-3

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

The relationship between bile duct pressure, bile duct dilatation, and jaundice after acute common bile duct obstruction and its clinical significance

Yunfu LV 1 , Xiaoguang GONG 1, Xiaoyu HAN 1, Shaowen WENG 1, Jie DENG 1, Shijie ZHANG 2, Yejuan LI 3

1 Department of General Surgery, Hainan Provincial People’s Hospital, Haikou, China; 2 Department of General Surgery, Guangdong Province Center’s Hospital of Kaiping City, Kaiping, China; 3 Department of Reproductive, Maternal and Child Care of Hainan Province, Haikou, China


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BACKGROUND: This study aimed to measure the relationship between bile duct pressure, bile duct dilatation, and jaundice after acute common bile duct obstruction and to investigate its clinical significance.
METHODS: A 3.5-mm tube connected to an automatic piezometric system was inserted in the proximal direction into the common bile duct of 12 dogs. Basic bile duct pressure and common bile duct diameter were measured. Peripheral venous blood was also obtained to measure basic serum bilirubin. The three-way stopcock was then turned to drop a methylene blue/saline solution into the common bile duct (20 drops/min) to cause bile duct obstruction. Bile duct pressure, common bile duct diameter, and serum bilirubin were measured at different times. Reflux to the liver of methylene blue-stained bile was also observed.
RESULTS: Before instillation of the methylene blue solution, bile duct pressure was 7.3863 ± 0.39960 mmHg, common bile duct diameter was 4 mm, total bilirubin (TB) was 10.1823 μmol/L, and liver color was normal. Seven minutes after instillation, bile duct pressure increased to 13.6025 ± 1.90625 mmHg, common bile duct diameter to 5.5 mm, and TB to 21.1456 μmol/L. At 15 minutes, bile duct pressure increased to 19.6625 ± 2.85882 mmHg, common bile duct diameter to 6 mm, and TB to 30.5662 μmol/L; the liver began to turn blue, indicating the reflux of bile into the liver. At 30 minutes, bile duct pressure increased to 33.0325 ± 5.57605 mmHg, common bile duct diameter to 6.7 mm, TB to 51.3505 μmol/L, and the liver became bluer. At 45 minutes, bile duct pressure was 23.0113 ± 3.31204 mmHg, common bile duct diameter was 7.5 mm, TB was 55.772 1μmol/L, and the liver color was dark blue. At 60 minutes, bile duct pressure was 18.9425 ± 1.18112 mmHg, common bile duct diameter was 7.5 mm, TB was 58.5169 μmol/L, and the liver color was dark blue. Significant differences were noted between each time point (P<0.05).
CONCLUSIONS: With the increase of bile duct pressure, biliary duct dilatation occurred prior to jaundice. The bile duct pressure no longer increased after peaking at 28-38 mmHg. The common bile duct diameter was also no longer increased after peaking at 7.5 mm. This indicates the self-confinement of both bile duct pressure and dilatation. Although serum bilirubin was not found to be self-confined, its increased rate was gradually reduced after 45 minutes.


KEY WORDS: Common bile duct diseases - Biliary tract - Dilatation - Jaundice

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