Objective: To investigate the mechanism of the antireflux action of intussusception valve constructed in the biliary intestinal limb of Roux-en-Y cholecystojejunostomy after biliary tract surgery. Methods: Twenty adult rabbits were equally randomized into the experimental group and control group. After common bile duct ligation, the biliary reconstruction in the experimental group was performed using Rouxen- Y cholecystojejunostomy with an intussusception valve created in the biliary intestinal limb, while the procedure in the control group was Roux-en-Y cholecystojejunostomy alone. Rabbits of the two groups were bred 3 months after surgery, and then their isoperistaltic pressure (IPP) and antiperistaltic pressure (APP) in the reconstructed biliary tract was measured, meanwhile a contrast X-ray examination was also performed. Results: The IPP values of the experimental group and control group were (5.91±1.46) cmH2O (1 cm H2O=0.098 kPa) and (4.82±0.39) cmH2O, and the APP values of them were (14.32±1.67) cmH2O and 胆肠Roux-en-Y 吻合胆道重建术是胆道疾病 切除或肝移植后常用的重建胆道的方式[1]。该术 式不仅重建了胆汁引流通道，也有一定的抗反流 作用。目前尽管诸多抗反流措施被应用于胆道重建 中[2-4]，也获得了相应的临床效果[5-6]，但胆道重建 术后逆行感染仍是一个未能完全解决的问题[7-10]。 作为一种抗反流措施，在重建胆道的同时于胆支 肠袢加行人工套叠瓣，经临床研究证实有确切的 抗反流作用[11-12]。但对套叠瓣抗反流作用的研 究尚缺乏基础实验的理论支持，且对其抗反流机 制的认识也缺乏客观依据。因此，本研究通过动 物实验测定套叠瓣两端胆道压力的变化，旨在探 讨套叠瓣在Roux -en-Y 胆道重建中的抗反流作 用机制。 1 材料与方法 1.1 材料 1.1.1 实验动物 成年健康家兔25 只， 体质量 2.5~3.0 kg，平均（2.8±0.5）kg。雌雄不限。购 于大理学院实验动物中心。 1.1.2 制剂和器械 20% 乌拉坦100 mL（ 大理 学院药学院制剂室配制）；20 mL:0.2 g 装丙泊 酚注射液（四川蜀乐药业股份有限公司生产）； 250 mL 装5% 葡萄糖氯化钠注射液；0.5 g 装氨 苄青霉素粉针剂。75% 乙醇棉球和5% 碘伏棉球。 76% 泛影葡胺20 mL/ 支。另备常用小手术器械 及用品，自制测压管数根。 1.2 实验方法 1.2.1 动物分组和观察指标 家兔随机分为实验 组和对照组。实验组行胆囊空肠Roux-en-Y 吻合 加胆支肠袢套叠瓣成形胆道重建术；对照组仅行 胆囊空肠Roux-en-Y 吻合胆道重建术。两组均在 确认成形的胆道通畅后，结扎胆总管。术后3 个 月再次手术测定胆道压力，并进行胆道造影。 1.2.2 手术操作 先用20% 乌拉坦3 mL/kg 经 兔耳缘静脉注射麻醉，仰卧位固定，持续5% 葡 萄糖氯化钠注射液缓慢静脉滴注。术中用丙泊酚 1~2 mg/kg 静脉注射以维持麻醉效果。取上腹部正 中切口， 探查胆囊、胆总管及小肠。在距Trietz 韧带15 cm 处游离肠系膜并切断小肠。远端上提 与胆囊吻合， 上提肠袢无张力， 约15 cm； 近端 小肠与远端小肠行端侧吻合，实验组在肠肠吻合 口上方约5 cm 处胆支肠袢上成形1 个套叠瓣， 即将近端肠袢套入远端肠袢0.5 cm（因成年家兔 小肠直径约1 cm， 套入瓣膜长度为小肠直径的 1/2），平均（0.5±0.1）cm。因肠壁较薄，未剥 去套入肠壁的浆膜层。丝线缝合固定。检查各吻 合口吻合确切通畅后，将胆总管用丝线结扎，逐 层关腹，术毕。对照组除未做套叠瓣外其余操作 与实验组相同。 术后每日注射氨苄青霉素0.25 g/kg 预防感 染， 连续用药3 d。术后第1 天即给予进食并开 始正常饲养。两组术后饲养条件相同，饲养观察 3 个月。3 个月后再次手术打开腹腔测压。 1.2.3 胆道测压和造影 3 个月后再次手术打 开腹腔， 直视下分别经套叠瓣近端和远端肠管 穿刺灌注测压[13]， 生理盐水灌注速度为30 mL/ min，用自制测压管测定套叠瓣两端胆道顺流压 （isoperistaltic pressure，IPP）和逆流压（antiperistaltic (4.90±0.37) cmH2O, respectively. Statistical analysis indicated that the APP value of experimental group was significantly higher than that of control group (P<0.01), but the IPP values between the two groups had no statistical difference (P>0.05); the APP values were significantly higher than the IPP values in experimental group (P<0.01), but the two values showed no statistical difference in control group (P>0.05). Contrast examination showed that the intussusception antireflux valve in the biliary limb of the small bowel could restrict the entering of contrast material into its upper segment. Conclusion: Intussusception valve exerts effective action against reflux in the biliary tract reconstructed with Roux-en-Y biliary-enteric anastamosis through increasing APP of the biliary limb of the Y structure.