Contaminação bacteriana da bile após colédoco-duodenostomia com ou em ligadura da ampola hepatopancreática

Abstract

As atuais controversias, sobre a coledoco-duodenostomia latero-lateral (CD L-L), estao relacionadas com as possiveis complicacoes tardias, principalmente a sindrome do coto coledocociano distal. Alem de se evitar a estenose da anastomose, a perviedade da ampola hepatopancreatica, parece ser fator importante na prevencao do aparecimento das complicacoes infecciosas apos CD-LL. Para avaliar qual a importancia da perviedade do coledoco distal na contaminacao bacteriana da via biliar principal apos CD-LL foram utilizados 21 caes adultos, da raca Beagle, fornecidos pelo Bioterio da (UFSC). Os animais foram divididos em 3 grupos, com 7 caes cada: Grupo 1 (controle) - Colecistectomia e cateterizacao do coledoco atraves do cistico. Grupo 2 - Coledoco-duodenostomia latero-lateral e colecistectomia com cateterizacao do coledoco atraves do cistico. Grupo 3 - Coledoco-duodenostomia latero-lateral, oclusao da ampola hepatopancreatica e colecistectomia com cateterizacao do coledoco atraves do cistico. Com 15, 30, e 60 dias os animais foram submetidos a estudos microbiologicos e colangiograficos. Os resultados mostraram que o modelo proposto para realizacao da CD-LL em caes, sem dilatacao previa da via biliar e viavel e nao determina estenose da anastomose. Ocorreu uma dilatacao do coledoco maior nos grupo 2 e 3 em relacao ao grupo 1, mas todas as anastomoses eram pervias. A CD-LL em caes levou ao aumento progressivo da contaminacao bacteriana da bile. Foram identificadas as bacterias Escherichia coli (53,2 %), Klebsiela (21,3 %), Enterococcus (13 %), Proteus (8,5 %) e Streptococcus fecalis (4 %). A oclusao da ampola hepatopancreatica aumenta a contaminacao bacteriana da bileThe today controversy about the side-to-side choledochoduodenostomy (CDD L-L) is relationed with the possible later complications, principally the sump syndrome. Besides avoiding the stenosis of the anastomosis, the patency of the terminal common bile duct, seems to be a very important factor in preventing the appearance of infection complications after the CDD L-L. Twenty-one full-blooded beagle family adult male dogs, were used to evaluate the importance of the patency of the terminal common bile duct in the bacterial contamination of the main bile ducts after CDD L-L. The animals were divided in 3 groups of 7 dogs each: Group 1 (Control) - cholecystectomy and drainage of the common bile duct by the cystic duct. Group 2 – side-to-side choledochoduodenostomy e cholecystectomy with drainage of the common bile duct by the cystic duct. Group 3 – side-to-side choledochoduodenostomy, occlusion of the terminal common bile duct and cholecystectomy with drainage of the common bile duct by the cystic duct. The animals were submitted to microbiological and roentgenographic studies in 15, 30 and 60 days. The results showed that the proposed model to the realization of the CDD L-L in dogs, without the prior dilatation of the common bile duct is passable and does not determines estenose of the anastomosis. A dilatation of the major common bile duct occurred in-groups 2 and 3 in relation to group 1, but all the anastomosis were pervious. The CDD L-L in dogs developed a progressive increase in the contamination of the bile. The bacteriologic studies identified Escherichia coli (53,2 %), Klebsiella sp. (21,3 %), Enterococcus sp. (13 %), Proteus sp. (8,5 %) and Streptococcus fecalis (4%). The occlusion of the distal common bile duct increased the bacterial contamination of the bile.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)BV UNIFESP: Teses e dissertaçõe