Roux-en-Y胆囊结肠胆汁分流对肝胆系统的影响
|
摘要
研究背景
进行性家族性肝内胆汁淤积(progressive familial intrahepatic cholestasis, PFIC)的非移植外科治疗方式主要包括部分胆汁的外分流术和内分流术。外分流术腹壁永久性胆道外瘘存在,影响儿童正常生活,家属往往难以接受。部分胆汁内分流术虽然避免了胆道外瘘,但是手术操作复杂,部分小肠受损,术后胆汁源性腹泻控制困难。为彻底解决以上问题,我们尝试采用Roux-en-Y胆囊结肠吻合胆汁内分流的新术式。目前有关这一新型改良术式鲜见报道。
进行性家族性肝内胆汁淤积,以严重的肝内胆汁淤积为主要特征,是一种罕见的常染色体隐性遗传病,发病率1/50000-1/100000,严重危害儿童健康。多数PFIC患儿确诊时已经处于终末期肝病状态。然而由于该症发病机制特殊,很难进行大样本的临床对照研究。为保证实验对象的均一性,动物实验无疑是最佳选择。
研究目的
本研究通过建立兔Roux-en-Y胆囊结肠吻合胆汁分流模型,从手术效果、胆汁动力、细菌分析及组织病理等多方面评估该术式的可行性和安全性,为临床应用提供一定的科学理论依据。
研究方法
选取24只幼兔随机分为三组,即：(1)正常阴性对照组(n=8),(2)空肠间置部分胆汁内分流组(n=8),(3)Roux-en-Y胆囊结肠吻合组(n=8)；分别实施假手术,空肠间置部分胆汁内分流术或Roux-en-Y胆囊结肠吻合胆汁分流术。饲养1年后,行核素肝胆显像评估模型：手术当日及术后1年留取胆汁和血清标本,检测总胆汁酸(total bile acid, TBA)浓度。核素显像完成后,留取肝、胆囊、结肠组织行细菌检测及病理组织学分析。另选取24只幼兔随机分为三组,即：(1)正常对照组(n=8),(2)30厘米长肝支组(n=8)和(3)10厘米短肝支组(n=8)；分别实施假手术或Roux-en-Y胆囊结肠吻合术。术后一月行核素肝胆动态显像,获得图像后应用感兴趣区(ROI)技术,由计算机自动绘制时间-放射性曲线。
实验结果
观察期间实验兔存活率100%,生长发育正常。经核素肝胆动态显像证实：胆囊结肠吻合组,部分胆汁自胆囊直接分流入结肠,建模成功。胆汁中平均TBA由(801.46±22.54)μmol/L下降至(214.08±12.24)μmol/L,均数下降73%;门静脉血中的TBA含量也呈下降表现,由(85.33±2.08)μmol/L降至(18.85±2.01)均数下降78%。细菌分析：胆囊结肠吻合组,Roux结肠支内细菌总数少于正常对照组,差异有统计学意义。空肠间置内分流组及胆囊结肠吻合组细菌培养阳性率分别为12.5%(4/32),9.375%(3/32)；差异不明显。大肠埃希杆菌为最常检出的细菌。病理组织分析发现：肝、胆囊、结肠组织结构基本正常,未见明显畸变结肠隐窝出现。核素动态显像证实：10厘米短支组胆汁排空最快,其20及35分钟胆汁排空率分别为(77.27±6.15)%和(90.39±1.49)%；分流比率最高,达(0.547±0.182),优于长支组(P<0.05)。长支组胆囊排空曲线呈波浪状。
实验结论
Roux-en-Y胆囊结肠吻合操作简单,安全可靠,胆汁内分流效果明显；胆囊结肠吻合不会增加细菌移位机率,手术木身与手术后感染无关；观察期内,胆囊结肠分流未诱导兔结肠发生肿瘤性病灶；99mTc-EH1DA核素动态显像技术可以有效评估胆汁分流比率,胆囊排空和整体肝功能变化；在兔的Roux-en-Y胆囊结肠吻合术动物模型中,10厘米短肝支组胆汁内分流效果优于30厘米长肝支组。
Background
The non-transplanting treatment for progressive familial intrahepatic cholestasis (PFIC) patients included partial external biliary diversion (PEBD) and partial internal biliary drainage (PIBD). PEBD was not readily accepted by all the patients and the families because of the permanent abdominal stoma. A stoma-free partial internal biliary drainage (PIBD) was a complex operation and diarrhea inducing by bile was difficult to treat. Small bowel resection must be carried out. To solve these problems, we have developed a novel approach, Roux-en-Y cholecystocolonic bypass, which partially diverts bile into colon directly without a jejunal conduit. Understanding about its impact on hepatobiliary physiology after this novel operation is limited.
PFIC was a rare autosomal recessive cholestatic disease with estimated incidence between1/50000and1/100000. Although three types of PFIC had been identified, early diagnosis was still difficult. When diagnosis of PFIC was confirmed, some patients had already progressed to liver fibrosis or cirrhosis. It was difficult to conduct large scale clinical trials or controlled studies. To ensure consistency in the research subjects, an animal model seemed to be the best choice for investigating the effects of cholecystocolonic bypass on hepatobiliary system.
Objective
The aim of the present study is to investigate, using a rabbit model, the changes in bile flow, total bile acid (TBA) level, bacterial and histological changes induced by Roux-en-Y cholecystocolonic anastomosis.
Methods
24rabbits, randomize divided into3groups:(1)normal control group (n=8),(2) PIBD group (n=8).(3) Roux-en-Y cholecysto-colonic anastomosis group(n=8).1year postoperation, dynamic biligraphy was performed to evaluate the reliability of this animal model. Pre-and post-opertive bile and blood were acquired to examine the change of TBA level. Tissues from the live, gallbladder and colon were also obtained to have pathological test. Bacterial changes also test postperatively. Moreover, another24rabbits were divided into3groups:(1) normal control (n=8),(2)30cm long limb group (n=8) and (3)10cm short limb group (n=8). Group2or3underwent Roux-en-Y cholecysto-colonic anastomosis with a30or10cm length Roux limb, and group1underwent sham operation. One month later, quantitative hepatobiliary scintigraphy was performed to detect the parameters of biliary dynamics using regions of interest (ROI) technology.
Results
All animals survived and developed normally during follow-up period. Biligraphy showed that bile was diverted into colon directly after cholecystocolonic anastomosis. Thus, the animal model was successful. TBA level in bile decreased73%from (801.46±22.54)μmol/L to (214.08±12.24)μmol/L. TBA level in portal vein was also decreased78%from (85.33±2.08)μmol/L to (18.85±2.01)μmol/L. After1year, examination of intestinal content showed a significantly decreased number of coliform in the Roux-en-Y cholecysto-colonic group as compared with native control animals. The total positive rate by bacterial culture was12.5%(4/32) and9.375%(3/32) respectively. No difference in the incidence was found among the two groups. E. coli was the most common bacterial cultured. No obvious pathologieal damage to the rabbit's liver, gallbladder and colon after cholecysto-colonic anastomosis was found. Hepatobiliary scintigraphy showed that E20and E35values were (77.27±6.15)%and (90.39±1.49)%respectively in short limb group. That is to say, gallbladder emptying in10cm long limb group was more rapidly than the other two groups. Moreover, the ratio of bile shunt was (0.547±0.182), which was also more than the ratio in the long limb group (P<0.05). The activity-time curve for the GB in the long limb group was like wave.
Conclusions
It is feasible and safe to hepatobiliary system after Roux-en-Y cholecysto-colonic anastomosis. Bile bypassed into colon directly, and TBA level in the body was decreased obviously. Roux-en-Y cholecysto-colonic anastomosis itself could not increase the incidence of bacterial translocation, postoperative infections, colorectal cancer induction. Scintigraphy99mTc-EH1DA to assess the ratio of bile diversion, gallbladder motility and overall liver function is a method with satisfactory reproducibility. The effect of bile diversion in10cm short limb rabbit model group is better than the30cm long limb group.
进行性家族性肝内胆汁淤积(progressive familial intrahepatic cholestasis, PFIC)的非移植外科治疗方式主要包括部分胆汁的外分流术和内分流术。外分流术腹壁永久性胆道外瘘存在,影响儿童正常生活,家属往往难以接受。部分胆汁内分流术虽然避免了胆道外瘘,但是手术操作复杂,部分小肠受损,术后胆汁源性腹泻控制困难。为彻底解决以上问题,我们尝试采用Roux-en-Y胆囊结肠吻合胆汁内分流的新术式。目前有关这一新型改良术式鲜见报道。
进行性家族性肝内胆汁淤积,以严重的肝内胆汁淤积为主要特征,是一种罕见的常染色体隐性遗传病,发病率1/50000-1/100000,严重危害儿童健康。多数PFIC患儿确诊时已经处于终末期肝病状态。然而由于该症发病机制特殊,很难进行大样本的临床对照研究。为保证实验对象的均一性,动物实验无疑是最佳选择。
研究目的
本研究通过建立兔Roux-en-Y胆囊结肠吻合胆汁分流模型,从手术效果、胆汁动力、细菌分析及组织病理等多方面评估该术式的可行性和安全性,为临床应用提供一定的科学理论依据。
研究方法
选取24只幼兔随机分为三组,即：(1)正常阴性对照组(n=8),(2)空肠间置部分胆汁内分流组(n=8),(3)Roux-en-Y胆囊结肠吻合组(n=8)；分别实施假手术,空肠间置部分胆汁内分流术或Roux-en-Y胆囊结肠吻合胆汁分流术。饲养1年后,行核素肝胆显像评估模型：手术当日及术后1年留取胆汁和血清标本,检测总胆汁酸(total bile acid, TBA)浓度。核素显像完成后,留取肝、胆囊、结肠组织行细菌检测及病理组织学分析。另选取24只幼兔随机分为三组,即：(1)正常对照组(n=8),(2)30厘米长肝支组(n=8)和(3)10厘米短肝支组(n=8)；分别实施假手术或Roux-en-Y胆囊结肠吻合术。术后一月行核素肝胆动态显像,获得图像后应用感兴趣区(ROI)技术,由计算机自动绘制时间-放射性曲线。
实验结果
观察期间实验兔存活率100%,生长发育正常。经核素肝胆动态显像证实：胆囊结肠吻合组,部分胆汁自胆囊直接分流入结肠,建模成功。胆汁中平均TBA由(801.46±22.54)μmol/L下降至(214.08±12.24)μmol/L,均数下降73%;门静脉血中的TBA含量也呈下降表现,由(85.33±2.08)μmol/L降至(18.85±2.01)均数下降78%。细菌分析：胆囊结肠吻合组,Roux结肠支内细菌总数少于正常对照组,差异有统计学意义。空肠间置内分流组及胆囊结肠吻合组细菌培养阳性率分别为12.5%(4/32),9.375%(3/32)；差异不明显。大肠埃希杆菌为最常检出的细菌。病理组织分析发现：肝、胆囊、结肠组织结构基本正常,未见明显畸变结肠隐窝出现。核素动态显像证实：10厘米短支组胆汁排空最快,其20及35分钟胆汁排空率分别为(77.27±6.15)%和(90.39±1.49)%；分流比率最高,达(0.547±0.182),优于长支组(P<0.05)。长支组胆囊排空曲线呈波浪状。
实验结论
Roux-en-Y胆囊结肠吻合操作简单,安全可靠,胆汁内分流效果明显；胆囊结肠吻合不会增加细菌移位机率,手术木身与手术后感染无关；观察期内,胆囊结肠分流未诱导兔结肠发生肿瘤性病灶；99mTc-EH1DA核素动态显像技术可以有效评估胆汁分流比率,胆囊排空和整体肝功能变化；在兔的Roux-en-Y胆囊结肠吻合术动物模型中,10厘米短肝支组胆汁内分流效果优于30厘米长肝支组。
Background
The non-transplanting treatment for progressive familial intrahepatic cholestasis (PFIC) patients included partial external biliary diversion (PEBD) and partial internal biliary drainage (PIBD). PEBD was not readily accepted by all the patients and the families because of the permanent abdominal stoma. A stoma-free partial internal biliary drainage (PIBD) was a complex operation and diarrhea inducing by bile was difficult to treat. Small bowel resection must be carried out. To solve these problems, we have developed a novel approach, Roux-en-Y cholecystocolonic bypass, which partially diverts bile into colon directly without a jejunal conduit. Understanding about its impact on hepatobiliary physiology after this novel operation is limited.
PFIC was a rare autosomal recessive cholestatic disease with estimated incidence between1/50000and1/100000. Although three types of PFIC had been identified, early diagnosis was still difficult. When diagnosis of PFIC was confirmed, some patients had already progressed to liver fibrosis or cirrhosis. It was difficult to conduct large scale clinical trials or controlled studies. To ensure consistency in the research subjects, an animal model seemed to be the best choice for investigating the effects of cholecystocolonic bypass on hepatobiliary system.
Objective
The aim of the present study is to investigate, using a rabbit model, the changes in bile flow, total bile acid (TBA) level, bacterial and histological changes induced by Roux-en-Y cholecystocolonic anastomosis.
Methods
24rabbits, randomize divided into3groups:(1)normal control group (n=8),(2) PIBD group (n=8).(3) Roux-en-Y cholecysto-colonic anastomosis group(n=8).1year postoperation, dynamic biligraphy was performed to evaluate the reliability of this animal model. Pre-and post-opertive bile and blood were acquired to examine the change of TBA level. Tissues from the live, gallbladder and colon were also obtained to have pathological test. Bacterial changes also test postperatively. Moreover, another24rabbits were divided into3groups:(1) normal control (n=8),(2)30cm long limb group (n=8) and (3)10cm short limb group (n=8). Group2or3underwent Roux-en-Y cholecysto-colonic anastomosis with a30or10cm length Roux limb, and group1underwent sham operation. One month later, quantitative hepatobiliary scintigraphy was performed to detect the parameters of biliary dynamics using regions of interest (ROI) technology.
Results
All animals survived and developed normally during follow-up period. Biligraphy showed that bile was diverted into colon directly after cholecystocolonic anastomosis. Thus, the animal model was successful. TBA level in bile decreased73%from (801.46±22.54)μmol/L to (214.08±12.24)μmol/L. TBA level in portal vein was also decreased78%from (85.33±2.08)μmol/L to (18.85±2.01)μmol/L. After1year, examination of intestinal content showed a significantly decreased number of coliform in the Roux-en-Y cholecysto-colonic group as compared with native control animals. The total positive rate by bacterial culture was12.5%(4/32) and9.375%(3/32) respectively. No difference in the incidence was found among the two groups. E. coli was the most common bacterial cultured. No obvious pathologieal damage to the rabbit's liver, gallbladder and colon after cholecysto-colonic anastomosis was found. Hepatobiliary scintigraphy showed that E20and E35values were (77.27±6.15)%and (90.39±1.49)%respectively in short limb group. That is to say, gallbladder emptying in10cm long limb group was more rapidly than the other two groups. Moreover, the ratio of bile shunt was (0.547±0.182), which was also more than the ratio in the long limb group (P<0.05). The activity-time curve for the GB in the long limb group was like wave.
Conclusions
It is feasible and safe to hepatobiliary system after Roux-en-Y cholecysto-colonic anastomosis. Bile bypassed into colon directly, and TBA level in the body was decreased obviously. Roux-en-Y cholecysto-colonic anastomosis itself could not increase the incidence of bacterial translocation, postoperative infections, colorectal cancer induction. Scintigraphy99mTc-EH1DA to assess the ratio of bile diversion, gallbladder motility and overall liver function is a method with satisfactory reproducibility. The effect of bile diversion in10cm short limb rabbit model group is better than the30cm long limb group.
引文
[1]Clayton RJ, Iber FL, Ruebner BH, et al. Byler's disease:Fatal familial intrahepatic cholestasis in an Amish kindred[J].I Pediatr,1965,67:1025-1028.
[2]Scheimann AO, Strautnieks SS, Knisely AS, Byrne JA, Thompson RJ. Finegold MJ. Mutations in bile salt export pump (ABCB11) in two children with progressive familial intrahepatic cholestasis and cholangiocarcinoma[J]. J Pediatr,2007,150(5): 556-559.
[3]Jacquemin E.Progressive familial intrahepatic cholestasis:genetic basis and treatment. In:Pediatric liver[J]. Clin Liver Dis,2000,4:753-763.
[4]Verena Keitel, Martin Burdelski,Ulrich Warskulat,et al.Expression and localization of hepatobiliary transport proteins in progressive familial intrahepatic cholestasis. Hepatology,2005,41(5):1160-1172
[5]Van Mil SWC, Klomp L, Bull LN, Houwen RH:FIC1 disease:A spectrum of intrahepatic cholestatic disorders[J]. Semin Liv Dis,2001,21:535-544.
[6]Cutillo L, Najimi M, Smets F, Janssen M, Safety of living-related liver transplantation for progressive familial intrahepatic cholestasis[J]. PediatrTransplantation,2006,10: 570-574
[7]Whitington PF, Whitington GL. Partial external diversion of bile for the treatment of intractable pruritus associated with intrahepatic cholestasis[J]. Gastroenterol,1988,95: 130-6.
[8]Ihab Halaweish, Walter J. Chwals. Long-term outcome after partial external biliary diversion for progressive familial intrahepatic cholestasis[J]. Journal of Pediatric Surgery,2010,45:934-937
[9]Bustorff-Silva J,Sbraggia Neto L,Olimpio H,et al.Partial internal biliary diversion through a cholecystojejunocolonic anastomosis-a novel surgical approach for patients with progressive familial intrahepatic cholestasis:a preliminary report[J]. Pediatr Surg,2007,42(8):1337-1340
[10]P.J.Kalicinski, H.Ismail, I.Jankowska, J.Pawlowska, etal. Surgical treatment of progressive familial intrahepatic cholestasis:comparison of partial exernal biliary diversion and ileal bypass[J].Eur J Pediatr Surg,2003,13:307.
[11]F.Gu n B, Erginel O,Durmaz S.etal.An outstanding non-transplant surgical intervention in progressive familial intrahepatic cholestasis:partial internal biliary diversion[J]. Pediatr Surg Int,2010,26:831-834
[1]刘垚,李龙.进行性家族性肝内胆汁淤积症的治疗进展[J].中华小儿外科杂志,2012,33(1)：59-61.
[2]Strubbe B, Geerts A. Van Vlierberghe H, Colle I.Progressive familial intrahepatic cholestasis and benign recurrent intrahepatic cholestasis:a review[J].Acta Gastroenterol Belg.2012 Dec;75(4):405-10.
[3]Jacquemin E. Progressive familial intrahepatic cholestasis[J].Clin Res Hepatol Gastroenterol.2012 Sep;36 Suppl 1-.S26-35. doi:10.1016/S2210-7401 (12)70018-9.
[4]Jankowska I, Socha P.Progressive familial intrahepatic cholestasis and inborn errors of bile acid synthesis[J].Clin Res Hepatol Gastroenterol.2012 Jun;36(3):271-4.
[5]毛一雷,张涛,桑新亭,等.应用单光子发射型计算机断层显像评价剩余肝功能的动物实验研究[J].中华外科杂志,2007,45(9)：609-612.
[6]Arnell H, Papadogiannakis N, Zemack H, Knisely AS, Nemeth A, Fischler B.Follow-up in children with progressive familial intrahepatic cholestasis after partial external biliary diversion[J].J Pediatr Gastroenterol Nutr.2010 Oct;51(4):494-9.
[7]Schukfeh N, Metzelder ML, Petersen C, Reismann M, Pfister ED, Ure BM, Kuebler JF.Normalization of serum bile acids after partial external biliary diversion indicates an excellent long-term outcome in children with progressive familial intrahepatic cholestasis[J].J Pediatr Surg.2012 Mar;47(3):501-5.
[8]Bustorff-Silva J,Sbraggia Neto L,Olimpio H,et al.Partial internal biliary diversion through a cholecystojejunocolonic anastomosis--a novel surgical approach for patients with progressive familial intrahepatic cholestasis:a preliminary report[J].Pediatr Surg,2007.42(8):1337-1340.
[9]Mochizuki K, Obatake M, Takatsuki M, Nakatomi A, Hayashi T, Okudaira S, Eguchi S. Partial internal biliary diversion for patients with progressive familial intrahepatic cholestasis type1[J].Pediatr Surg Int.2012 Jan;28(1):51-4.
[10]Halaweish I, Chwals WJ Long-term outcome after partial external biliary diversion for progressive familial intrahepatic cholestasis[J].J Pediatr Surg.2010 May;45(5):934-7.
[11]Koshy A, Ramesh H, Mahadevan P, Mukkada RJ, Francis VJ, Chettupuzha AP, Mathew PG, Cyriac J, Augustine P.Progressive familial intrahepatic cholestasis:A case with improvement in liver tests and growth following partial external biliary diversion[J].Indian J Gastroenterol.2009 May-Jun;28(3):107-8.
[12]Hoekstra LT, Rietkerk M, van Lienden KP, van den Esschert JW, Schaap FG, van Gulik TM.Bile salts predict liver regeneration in rabbit model of portal vein embolization[J].J Surg Res.2012 Dec;178(2):773-8.
[13]Davies RR,Davies JA.Rabbit gastrointestinal physiology [J]. Vet Clin Exot Anim,2003,6(1):139-153.
[14]朱安东,陈德兴,周金铭.腹腔镜下胆总管空肠Roux-en-Y吻合术在胆系手术中的应用[J].中国微创外科杂志,2010,10(2)：274-278.
[15]李龙,张金山,张军,等.胆囊结肠吻合治疗进行性家族性肝内胆汁淤积症的探讨[J].中华小儿外科杂志,2011,32(10)：31-35.
[16]Wang R, Lam P, Liu L, Forrest D, Yousef IM, Mignault D, Phillips MJ, Ling V. Severe cholestasis induced by cholic acid feeding in knockout mice of sister of P-glycoprotein[J].Hepatology.2003 Dec;38(6):1489-99.
[17]Hollands CM, Rivera-Pedrogo FJ, Gonzalez-Vallina R, et al. Heal exclusion for Byler's disease:an alternative surgical approach with promising early results for pruritus[J]. J Pediatr Surg 1998;33(2):220-4.
[1]岳茂兴.胃肠道功能障碍及衰竭的诊断和治疗[J].世界华人消化杂志,2002,10(1)：3-6
[2]邓丽静,康焰.肠黏膜屏障与保护[J].中国呼吸与危重监护杂志,2004,3(5)：327-328
[3]Kulinich LI, Fish NG, Mazitova OP, Dratvin SA, Birger MO.Using SIB and API kits to identify and biotype enterobacteria of different origin[J].J Hyg Epidemiol Microbiol Immunol.1987:31 (3):287-92.
[4]Phillips SB, Amsterdam D.API computer profiles:correlation of API 20E with API 10S[J].J Clin Microbiol.1977;6(6):645-6.
[5]Carlisle EM, Morowitz MJ.Pediatric surgery and the human microbiome[J].J Pediatr Surg.2011 Mar;46(3):577-84. doi:10.1016/j.jpedsurg.2010.12.018.
[6]Begley M, Gahan C G,Hill C.The interaction between bacteria and bile[J].FEMS Microbiol Rev,2005,29(4):625-651
[7]Sozen S, Topuz O, Uzun AS, Cetinkunar S, Das K.Prevention of bacterial translocation using glutamine and melatonin in small bowel ischemia and reperfusion in rats[J].Ann Ital Chir.2012;83(2):143-8.
[8]Mangell P, Thorlacius H, Syk I, Ahrne S, Molin G, Olsson C, Jeppsson B.Lactobacillus plantarum 299v does not reduce enteric bacteria or bacterial translocation in patients undergoing colon resection[J].Dig Dis Sci.2012 Jul;57(7):1915-24.
[9]Lundell L.Use of probiotics in abdominal surgery[J].Dig Dis.2011;29(6):570-3.
[10]乔治,黎沾良,李基业,陆连荣,吕艺,于勇,黎君友,孙丹.腹部外科手术后肠道细菌移位及肠道屏障的研究[J].中华急诊医学杂志,2004,13(10)：664-666.
[11]苏永辉,贾英斌,潘海燕,郭兆旺,谢玉研,张百萌.肝门阻断对大鼠肠道细菌移位和内毒素血症的影响[J].中山大学学报,2010,31(6)：867-871.
[12]Park JJ, Chung KY, Nam YS.Two-day fasting prior to intestinal ischemia-reperfusion injury on bacterial translocation in rats[J].J Invest Surg.2011;24(6):262-6.
[13]O'Boyle CJ,MacFie J,Mitchell CJ,et al.Microbiology of bacterial translocation in humans[J].Gut,1998,42:29-35
[14]梁力建李绍强关于胆肠吻合术一些问题的思考[J].中国实用外科杂 志.2004,24(1)：41-42.
[15]Madden JL, Chun JY, Kandalaft S, et al. Choledochoduo-denostomy:an unjustly maligned surgical procedure[J]. AmJ Surg.1970,119:45-54.
[16]钱礼,张启瑜,俞蔚明.胆肠吻合术后继发胆管炎的发病机制和各型胆肠吻合术的疗效分析[J].浙江医学,1983,5：1-7.
[17]曾宪九,张建希,汪忠镐,等.空肠Y型吻合后预防返流的进一步经验[J].中华外科杂志,1984,22：543-544.
[18]Luketic VA, Sanyal AJ. The current status of ursodeoxycholate in the treatment of chronic cholestatic liver disease[J]. Gastroenter-ologist,1994; 2:74-9.
[19]Wells CL, Jechorek RP, Erlandsen SL. Inhibitory effect of bile on bacterial invasion of enterocytes:possible mechanism for increased translocation associated with obstructive jaundice[J]. Crit. Care Med.1995; 23:301-7.
[20]刘建强,张志坚,王雯,林克荣,朱金照,林晴.胆汁酸对肝硬化大鼠肠道细菌移位和内毒素血症的影响[J].福建医科大学学报,2006,40(3)：231-236.
[21]Aldemir M, Geyik MF, Kokoglu OF, e t al. Effects of ursodeoxycholic acid, glutamine and polyclonal immunogl obu lins on bacterial translocation in common bile duct ligated rats[J].A N Z J Surg,2003,73(9):722-726.
[22]Ogat a Y, Nishi M, Nakayama H, e ta 1. Rol e of bile in in test inal barrier fun ct ion and it s in hibit ory ef feet on bact eri al t ran slocat ion in ob st ruct ive jaundice in rats [J]. J S urg Res,2003,115(1):18-23.
[23]DrydenL.Surgical site infection[J].NursStand.2012,4;27(13):59.
[24]Gagliardi AR, Fenech D, Eskicioglu C, Nathens AB, McLeod R.Factors influencing antibiotic prophylaxis for surgical site infection prevention in general surgery:a review of the literature [J]. Can J Surg.2009;52(6):481-9.
[25]朱会英,李艳春,向佩莹,王艳,许蔓春.肝胆外科手术部位感染目标性监测分析[J].中华医院感染学杂志,2012,,22(21)：4755-4757.
[1]Bird RP, McLellan EA. Bruce WR. Aberrant crypts, putative precancerous lesions, in the study of the role of diet in the aetiology of colon cancer[J]. Cancer Surv 1989; 8:189-200
[2]Pretlow TP, Barrow BJ, Ashton WS, O'Riordan MA, Pretlow TG, Jurcisek JA, Stellato TA. Aberrant crypts:putative pre-neoplastic foci in human colonic mucosa[J]. Cancer Res 1991;51:1564-1567
[3]Alrawi SJ, Schiff M, Carroll RE, Dayton M, Gibbs JF, Kulavlat M, Tan D, Berman K, Stoler DL, Anderson GR. Aberrant crypt foci[J].Anticancer Res.2006 Jan-Feb;26(1A):107-19.
[4]Sato T, Stange DE, Ferrante M, Vries RG, Van Es JH, Van den Brink S, Van Houdt WJ, Pronk A, Van Gorp J, Siersema PD, Clevers H.Long-term expansion of epithelial organoids from human colon, adenoma, adenocarcinoma, and Barrett's epithelium[J].Gastroenterology.2011 Nov;141(5):1762-72.
[5]Sikalidis AK, Fitch MD, Fleming SE.Diet Induced Obesity Increases the Risk of Colonic Tumorigenesis in Mice[J],Pathol Oncol Res.2013 Mar 28.
[6]Lin OS. Acquired risk factors for colorectal cancer[J].Methods Mol Biol. 2009;472:361-72.
[7]Ueyama Y, Monden Y, He XB, Lin CX, Momen MA, Mimura S, Umemoto A.Effects of bile acids on 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine-induced aberrant crypt foci and DNA adduct formation in the rat colon[J]. J Exp Clin Cancer Res. 2002;21(4):577-83.
[8]AltieriA,PelueehiC,TalaminiR,etal.Choleeysteetomy and the risk of colorectal cancer in Italy[J].Br J Cancer,2004,90(9):1753-1755.
[9]Laurie A.M.,Sutherland,Ranjana,P.Bird.The effect of chenodeoxycholic acid on the development of aberrant crypt foci in the rat colon[J]. Cancer Letters 1994,76:101-107.
[10]Kawabata K, T anaka T, Murakami T, Okada T, Murai h, Yamamoto T, hara A, Shimizu M, Yamada Y, Matsunaga K, Kuno T, Yoshimi n, Sugie S and Mori h. Dietary prevention of azoxymethane-induced colon carcinogenesis with rice-germ in F344 rats[J]. Carcinogenesis 1999Nov;20(11):2109-2115.
[11]Bernstein, C., Holubec, H., Bhattacharyya, A.K., Nguyen. H., Payne, C.M., Zaitlin, B..Bernstein, H. Carcinogenicity of deoxycholate. a secondary bile acid[J]. Arch.Toxicol.2011.85.863-871.
[12]Butler. L.M., Wang, R.. Koh. W.P., Stern, M.C.. Yuan, J.M., Yu. M.C.. Marine n-3 and saturated fatty acids in relation to risk of colorectal cancer in Singapore Chinese: a prospective study[J]. Int. J. Cancer,2009.124,678-686.
[13]Carroll, K.K.,. Dietary fats and cancer[J]. Am. J. Clin. Nutr.1991,53,1064S-1067S.
[14]Reddy. B.S., Diet and excretion of bile acids[J]. Cancer Res.1981.41,3766-3768.
[15]Reddy, B.S., Hanson, D., Mangat, S., Mathews, L., Sbaschnig, M., Sharma, C., Simi, B. Effect of high-fat, high-beef diet and of mode of cooking of beef in the diet on fecal bacterial enzymes and fecal bile acids and neutral sterols[J]. J. Nutr.1980.110,1880-1887.
[16]Bayerdorffer, E., Mannes, G.A., Ochsenkuhn, T., Dirschedl, P., Wiebecke, B.,Paumgartner, G., Unconjugated secondary bile acids in the serum of patients with colorectal adenomas[J]. Gut,1995.36,268-273.
[17]Reddy, B.S., Wynder, EX.. Metabolic epidemiology of colon cancer. Fecal bile acids and neutral sterols in colon cancer patients and patients with adenomatous polyps[J]. Cancer,1977,39,2533-2539.
[18]Tong, J.L., Ran, Z.H., Shen, J., Fan, G.Q., Xiao, S.D. Association between fecal bile acids and colorectal cancer:a meta-analysis of observational studies. Yonsei Med. J. 2008,49,792-803.
[19]Bernstein, C., Holubec, H., Bhattacharyya, A.K., Nguyen, H., Payne, C.M., Zaitlin, B.,Bernstein, H.. Carcinogenicity of deoxycholate, a secondary bile acid[J]. Arch.Toxicol.2011,85,863-871.
[20]Debruyne, P.R., Bruyneel, E.A., Li, X., Zimber, A., Gespach, C, Mareel, M.M., The role of bile acids in carcinogenesis[J]. Mutat. Res.2001,480-481,359-369.
[21]STEVENSRG,SWEDEH,ROSENBERGDW.EPideology of colonic aberrant crypt foci:review and analysis of existing studies[J].CancerLett,2007,252(2):171-183
[22]Bird RP.GOOD CK.The significance of aberrant crypt foci in understanding the pathogenesis of colon cancer[J].ToxicolLett,2000,112-113:395-402
[23]Orlando, F.A.;Tan, D.; Baltodano, J.D.; Khoury, T.; Gibbs, J.F.; Hassid,V.J.; Ahmed,B.H.;Alrawi,S.J. Aberrant crypt foci as precursors in colorectal cancer progression[J]. J. Surg. Oncol.2008,98,207-213.
[24]Humphries A, Wright NA.Colonic crypt organization and tumorigenesis[J]. Nat Rev Cancer.2008,8(6):415-24.
[25]Seraj MJ,UmemotoA,KajikawaA,MimuraS,KinouchiT,OhnishiY,MondenY.Effects of dietary bile acids on formation of azoxymethane-induced aberrant crypt foci in F344 rats[J].Cancer Lett 1997,115:97-103.
[26]Lin C,Umemoto A,Jabed MS,Mimura S,Monden Y.Effect of bile acids on formation of azoxymethane-induced aberrant crypt foci in colostomized F344 rat colon[J].Cancer Lett 169:121-126,2001
[27]Momen MA, Monden Y, Houchi H, Umemoto A. Effect of ursodeoxycholic acid on azoxymethane-induced Aberrant crypt foci formation in rat colon:in vitro potential role of intracellular Ca2+[J].J Med Invest.2002 Feb;49(1-2):67-73.
[28]Serfaty, L., Bissonnette, M., Poupon, R.,2010. Ursodeoxycholic acid and chemoprevention of colorectal cancer[J]. Gastroenterol. Clin. Biol.34,516-522.
[29]Tung, B.Y., Emond, M.J., Haggitt, R.C., Bronner, M.P., Kimmey, M.B., Kowdley, K.V.,Brentnall, T.A.,2001. Ursodiol use is associated with lower prevalence of colonic neoplasia in patients with ulcerative colitis and primary sclerosing cholangitis[J].Ann.Int.Med.134,89-95
[30]Choi HJ,Jung ZK,Kim SS,et al.Proliferating cell nuclear antigen expression and its relationship to malignancy potential in invasive colorectal carcinomas[J].Dis Colon Rectum,1997,40(1):51-59.
[31]吴成秋,陈雯,张桥,等.二甲肼诱导大鼠肠癌过程中增殖细胞核抗原的表达[J].中国癌症杂志,2000,10(6)：553.
[32]Maeda K, Chung Y, Onoda N, et al. Proliferating cell nuclear antigen labeling index of preoperative biopsy specimens in gastric carcinoma with special reference to prognosis [J]. Cancer,1994,73(3):528.
[1]Bertalan V, Szepes A, Lonovics J. Madacsy L.Assessment of the reproducibility of quantitative hepatobiliary scintigraphy (QHBS) in patients with sphincter of Oddi dysfunction (SOD)--inappropriate method or intermittent disease[J]?Hepatogastroenterology.2006 Mar-Apr;53(68):160-5.
[2]Thomsen MK, Lange A, Frokiaer J.The role of hepatobiliary scintigraphy in neonates with persistant jaundice[J].Ugeskr Laeger.2005 Sep 26;167(39):3675-8.
[3]Toftdahl DB, Hojgaard L, Winkler K.Dynamic cholescintigraphy:induction and description of gallbladder emptying[J].J Nucl Med.1996 Feb;37(2):261-6.
[4]李龙,张金山,张军,等.胆囊结肠吻合治疗进行性家族性肝内胆汁淤积症的探讨[J].中华小儿外科杂志,2011,32(10)：31-35.
[5]Davis AR, Rosenthal P, Newman TB. Nontransplant surgical interventions in progressive familial intrahepatic cholestasis[J]. Journal of Pediatric Surgery,2009,44(4):821-827.
[6]Ron Rees Davies, BVSc, CertZooMed, etal. Rabbit gastrointestinal physiology[J].Vet Clin Exot Anim,2003,6:139-153.
[7]毛一雷,张涛,桑新亭,等.应用单光子发射型计算机断层显像评价剩余肝功能的动物实验研究[J].中华外科杂志,2007,45(9)：609-612.
[8]Raithel M, Nagel A, Maiss J, Wildner D, Hagel AF, Braun S, Diebel H, Hahn EG.Conventional endoscopic retrograde cholangiopancreaticography vs the Olympus V-scope system[J].World J Gastroenterol.2013 Mar 28;19(12):1936-42. doi:10.3748/wjg.vl9.i12.1936.
[9]Uchiyama K, Kuniyasu Y, Higashi ST, Shen Y, Niio Y, Hasebe S, Matsuoka S, Shima H, Shinohara H, Takizawa K, Obuchi M, Honda M, Hirata N.Precision of the gallbladder ejection fraction obtained with Tc-99m-pyridoxyl-5-methyl-tryptophan (99mTc-PMT) hepatobiliary scintigraphy as compared with the contraction ratio in three-dimensional computed tomography [J]. Ann Nucl Med.1997 May;1(2):123-8.
[10]许国铭.胆道运动功能检测及临床意义[J].北京医学,1998,20(增刊)：11-15;
[11]Santhosh S, Mittal BR, Arun S, Sood A, Bhattacharya A, Kochhar R.Quantitative cholescintigraphy with fatty meal in the diagnosis of sphincter of Oddi dysfunction and acalculous cholecystopathy[J].Indian J Gastroenterol.2012 Jul;31(4):186-90. Epub 2012 Sep 2.
[12]Shimotakahara A, Yamataka A, Yanai T, Kobayashi H. Okazaki T, Lane GJ, Miyano T. Roux-en-Y hepaticojejunostomy or hepaticoduodenostomy for biliary reconstruction during the surgical treatment of choledochal cyst:which is better[J]?Pediatr Surg Int.2005 Jan;21(1):5-7.
[13]Felder SI. Menon VG, Nissen NN, Margulies DR, Lo S, Colquhoun SD. Hepaticojejunostomy Using Short-Limb Roux-en-Y Reconstruction[J]. JAMA Surg.2013 Mar 1;148(3):253-7. doi:10.1001/jamasurg.2013.601.
[14]Mei Diao, Long Li, Jin-Zhe Zhang, etal. A shorter loop in Roux-Y hepatojejunostomy reconstruction for choledochal cysts is equally effective: preliminary results of a prospective randomized study[J]. Journal of Pediatric Surgery,2010,45:845-847.
[15]Gustavsson S, Ilstrup DM, Morrison P, Kelly KA. Roux-en-Y stasis syndrome after gastrectomy[J]. Am J Surg,1988,155:490-494.
[16]Robson Azevedo Dutra,Wemberton Martins Araujo,Jose Ivan de Andrade. The effects of Roux-en-Y limb length on gastric emptying and enterogastric reflux in rats. Acta Cirurgica Brasileira,2008,23(2):179-183.
[17]谭毓铨,等.论胆肠吻合术[J].中国普通外科杂志,2005,14(8)：564-566.
[18]梁力建,李绍强.关于胆肠吻合术一些问题的思考[J].中国实用外科杂志,2004,24(1)：41-42.
[19]Onodera Y,Takahashi K,Sugai Y,et al.Evaluation of the liver uptake rate measured by 99mTc-GSA SPECT to assess liver function[J].Kaku Igaku,1999,36(1):37-44.
[1]Emerick KM, Elias MS. Melin-Aldana H. et al.Bile composition in alagille syndrome and PFIC patients having partial external biliary diversion[J].BMC Gastroenterol,2008,8:47-52.
[2]MelterM,RodeckB,KardorffR.Progressive familial intrahepatic cholestasis partial bilia ry diversion normalizes serum lipids and improves growth in noncirrhotic patients[J]. Am J Gastroenterol,2000,95(12):3522-3528.
[3]Arnell H, Papadogiannakis N, Zemack H, et al. Follow-up in children with progressive familial intrahepatic cholestasis after partial external biliary diversion [J]. J Pediatr Gastroenterol Nutr,2010,51(4):494-499.
[4]Kalicinski PJ, Ismail H, Jankowska I, et al. Surgical treatment of progressive familial intrahepatic cholestasis:comparison of partial external biliary diversion and ileal bypass[J]. Eur J Pediatr Surg,2003,13:307-311.
[5]Bustorff-Silva J, Sbraggia Neto L, Olimpio H, et al. Partial internal biliary diversion through a cholecystojejunocolonic anastomosis-a novel surgical approach for patients with progressive familial intrahepatic cholestasis:a preliminary report[J]. Pediatr Surg,2007,42(8):1337-1340.
[6]Gun F, Erginel B, Durmaz O, et al. An outstanding non-transplant surgical intervention in progressive familial intrahepatic cholestasis:partial internal biliary diversion[J]. Pediatr Surg Int,2010,26(8):831-834.
[7]Ganesh R, Suresh N, Sathiyasekeran M, et al. Partial internal biliary diversion:a solution for intractable pruritus in progressive familial intrahepatic cholestasis type 1[J]. Saudi J Gastroenterol,2011,17:212-214.
[8]Schukfeh N, Metzelder ML, Petersen C, et al. Normalization of serum bile acids after partial external biliary diversion indicates an excellent long-term outcome in children with progressive familial intrahepatic cholestasis[J]. J Pediatr Surg,2012,47:501-505.
[9]Yang H, Porte RJ, Verkade HJ, et al. Partial external biliary diversion in children with progressive familial intrahepatic cholestasis and Alagille disease[J].J Pediatr Gastroenterol Nutr,2009,49:216-221.
[10]李龙,张金山,张军,等.胆囊结肠吻合治疗进行性家族性肝内胆汁淤积症的探讨[J].中华小儿外科杂志,2011,32(10)：31-35.
[11]Davis AR, Rosenthal P, Newman TB. Nontransplant surgical interventions in progressive familial intrahepatic cholestasis[J]. J Pediatr Surg,2009,44(4):821-827.
[12]Diao M, Li L, Zhang JS, Ye M,et al. Laparoscopic cholecystocolostomy:a novel surgical approach for the treatment of progressive familial intrahepatic cholestasis [J].Ann Surg,2012, Nov 26..[Epub ahead of print].
[1]刘垚,李龙.进行性家族性肝内胆汁淤积症的治疗进展[J].中华小儿外科杂志,2012,33(1)：59-61.
[2]Mochizuki K, Obatake M, Takatsuki M, Nakatomi A, Hayashi T, Okudaira S, Eguchi S. Partial internal biliary diversion for patients with progressive familial intrahepatic cholestasis type 1[J]. Pediatr Surg Int.2012;28(1):51-4.
[3]Gun F, Erginel B,Durmaz O,Sokucii S,Salman T,CelikA.An outstanding non-transplant surgical intervention in progressive familial intrahepatic cholestasis: partial internal biliary diversion[J]. Pediatr Surg Int,2010,26(8):831-4.
[4]李龙,张金山,张军,等.胆囊结肠吻合治疗进行性家族性肝内胆汁淤积症的探讨[J].中华小儿外科杂志,2011,32(10)：31-35.
[5]Whitington PF, Whitington GL. Partial external diversion of bile for the treatment of intractable pruritus associated with intrahepatic cholestasis[J]. Gastroenterology 1988;95(1):130-6.
[6]Bustorff-Silva J, Sbraggia Neto L, Olimpio H, et al. Partial internal biliary diversion through a cholecystojejunocolonic anastomosis-a novel surgical approach for patients with progressive familial intrahepatic cholestasis:a preliminary report [J]. J Pediatr Surg 2007; 42(8):1337-40.
[7]Metzelder ML, Bottlander M, Melter M, et al. Laparoscopic partial external biliary diversion procedure in progressive familial intrahepatic cholestasis:a new approach[J]. Surg Endosc 2005; 19(12):1641-3.
[8]Sharma D, Shah UH, Sibal A, Chowdhary SK. Cholecystoappendicostomy for progressive familial intrahepatic cholestasis[J]. Indian Pediatr,2010,47(7):626-8.
[9]Hollands CM. Rivera-Pedrogo FJ. Gonzalez-Vallina R, et al. Heal exclusion for Byler's disease:an alternative surgical approach with promising early results for pruritus[J]. J Pediatr Surg 1998;33(2):220-4.
[10]Kurbegov AC, Setchell KD, Haas JE, et al. Biliary diversion for progressive familial intrahepatic cholestasis:improved liver morphology and bile acid profile[J]. Gastroenterology 2003; 125(4):1227-34.
[11]Yang H, Porte RJ, Verkade HJ, De Langen ZJ, Hulscher JB. Follow-up in children with progressive familial intrahepatic cholestasis after partial external biliary diversion [J]J Pediatr Gastroenterol Nutr,2009,49(2):216-21.
[12]Ng VL, Ryckman FC, Porta G, et al. Long-term outcome after partial external biliary diversion for intractable pruritus in patients with intrahepatic cholestasis[J]. J Pediatr Gastroenterol Nutr 2000;30(2):152-6.
[13]Ekinci S, Karnak I, Giirakan F, Yuce A, Senocak ME, Cahit Tanyel F, Buyukpamukcu N. Partial External Biliary Diversion for the Treatment of Intractable Pruritus in Children with Progressive Familial Intrahepatic Cholestasis:Report of Two Cases [J]. Surg Today,2008;38(8):726-30.
[14]Schukfeh N, Metzelder ML, Petersen C, Reismann M, Pfister ED, Ure BM, Kuebler JF. Normalization of serum bile acids after partial external biliary diversion indicates an excellent long-term outcome in children with progressive familial intrahepatic cholestasis[J]. J Pediatr Surg.2012,47(3):501-5.
[15]Emond JC, Whitington PF. Selective surgical management of progressive familial intrahepatic cholestasis (Byler's disease). J Pediatr Surg 1995:30(12):1635-41.
[16]Arnell H, Bergdahl S, Papadogiannakis N, Nemeth A, Fischler B. Preoperative observations and short-term outcome after partial external biliary diversion in 13 patients with progressive familial intrahepatic cholestasis [J]. J Pediatr Surg.2008;43(7):1312-20.
[2]Scheimann AO, Strautnieks SS, Knisely AS, Byrne JA, Thompson RJ. Finegold MJ. Mutations in bile salt export pump (ABCB11) in two children with progressive familial intrahepatic cholestasis and cholangiocarcinoma[J]. J Pediatr,2007,150(5): 556-559.
[3]Jacquemin E.Progressive familial intrahepatic cholestasis:genetic basis and treatment. In:Pediatric liver[J]. Clin Liver Dis,2000,4:753-763.
[4]Verena Keitel, Martin Burdelski,Ulrich Warskulat,et al.Expression and localization of hepatobiliary transport proteins in progressive familial intrahepatic cholestasis. Hepatology,2005,41(5):1160-1172
[5]Van Mil SWC, Klomp L, Bull LN, Houwen RH:FIC1 disease:A spectrum of intrahepatic cholestatic disorders[J]. Semin Liv Dis,2001,21:535-544.
[6]Cutillo L, Najimi M, Smets F, Janssen M, Safety of living-related liver transplantation for progressive familial intrahepatic cholestasis[J]. PediatrTransplantation,2006,10: 570-574
[7]Whitington PF, Whitington GL. Partial external diversion of bile for the treatment of intractable pruritus associated with intrahepatic cholestasis[J]. Gastroenterol,1988,95: 130-6.
[8]Ihab Halaweish, Walter J. Chwals. Long-term outcome after partial external biliary diversion for progressive familial intrahepatic cholestasis[J]. Journal of Pediatric Surgery,2010,45:934-937
[9]Bustorff-Silva J,Sbraggia Neto L,Olimpio H,et al.Partial internal biliary diversion through a cholecystojejunocolonic anastomosis-a novel surgical approach for patients with progressive familial intrahepatic cholestasis:a preliminary report[J]. Pediatr Surg,2007,42(8):1337-1340
[10]P.J.Kalicinski, H.Ismail, I.Jankowska, J.Pawlowska, etal. Surgical treatment of progressive familial intrahepatic cholestasis:comparison of partial exernal biliary diversion and ileal bypass[J].Eur J Pediatr Surg,2003,13:307.
[11]F.Gu n B, Erginel O,Durmaz S.etal.An outstanding non-transplant surgical intervention in progressive familial intrahepatic cholestasis:partial internal biliary diversion[J]. Pediatr Surg Int,2010,26:831-834
[1]刘垚,李龙.进行性家族性肝内胆汁淤积症的治疗进展[J].中华小儿外科杂志,2012,33(1)：59-61.
[2]Strubbe B, Geerts A. Van Vlierberghe H, Colle I.Progressive familial intrahepatic cholestasis and benign recurrent intrahepatic cholestasis:a review[J].Acta Gastroenterol Belg.2012 Dec;75(4):405-10.
[3]Jacquemin E. Progressive familial intrahepatic cholestasis[J].Clin Res Hepatol Gastroenterol.2012 Sep;36 Suppl 1-.S26-35. doi:10.1016/S2210-7401 (12)70018-9.
[4]Jankowska I, Socha P.Progressive familial intrahepatic cholestasis and inborn errors of bile acid synthesis[J].Clin Res Hepatol Gastroenterol.2012 Jun;36(3):271-4.
[5]毛一雷,张涛,桑新亭,等.应用单光子发射型计算机断层显像评价剩余肝功能的动物实验研究[J].中华外科杂志,2007,45(9)：609-612.
[6]Arnell H, Papadogiannakis N, Zemack H, Knisely AS, Nemeth A, Fischler B.Follow-up in children with progressive familial intrahepatic cholestasis after partial external biliary diversion[J].J Pediatr Gastroenterol Nutr.2010 Oct;51(4):494-9.
[7]Schukfeh N, Metzelder ML, Petersen C, Reismann M, Pfister ED, Ure BM, Kuebler JF.Normalization of serum bile acids after partial external biliary diversion indicates an excellent long-term outcome in children with progressive familial intrahepatic cholestasis[J].J Pediatr Surg.2012 Mar;47(3):501-5.
[8]Bustorff-Silva J,Sbraggia Neto L,Olimpio H,et al.Partial internal biliary diversion through a cholecystojejunocolonic anastomosis--a novel surgical approach for patients with progressive familial intrahepatic cholestasis:a preliminary report[J].Pediatr Surg,2007.42(8):1337-1340.
[9]Mochizuki K, Obatake M, Takatsuki M, Nakatomi A, Hayashi T, Okudaira S, Eguchi S. Partial internal biliary diversion for patients with progressive familial intrahepatic cholestasis type1[J].Pediatr Surg Int.2012 Jan;28(1):51-4.
[10]Halaweish I, Chwals WJ Long-term outcome after partial external biliary diversion for progressive familial intrahepatic cholestasis[J].J Pediatr Surg.2010 May;45(5):934-7.
[11]Koshy A, Ramesh H, Mahadevan P, Mukkada RJ, Francis VJ, Chettupuzha AP, Mathew PG, Cyriac J, Augustine P.Progressive familial intrahepatic cholestasis:A case with improvement in liver tests and growth following partial external biliary diversion[J].Indian J Gastroenterol.2009 May-Jun;28(3):107-8.
[12]Hoekstra LT, Rietkerk M, van Lienden KP, van den Esschert JW, Schaap FG, van Gulik TM.Bile salts predict liver regeneration in rabbit model of portal vein embolization[J].J Surg Res.2012 Dec;178(2):773-8.
[13]Davies RR,Davies JA.Rabbit gastrointestinal physiology [J]. Vet Clin Exot Anim,2003,6(1):139-153.
[14]朱安东,陈德兴,周金铭.腹腔镜下胆总管空肠Roux-en-Y吻合术在胆系手术中的应用[J].中国微创外科杂志,2010,10(2)：274-278.
[15]李龙,张金山,张军,等.胆囊结肠吻合治疗进行性家族性肝内胆汁淤积症的探讨[J].中华小儿外科杂志,2011,32(10)：31-35.
[16]Wang R, Lam P, Liu L, Forrest D, Yousef IM, Mignault D, Phillips MJ, Ling V. Severe cholestasis induced by cholic acid feeding in knockout mice of sister of P-glycoprotein[J].Hepatology.2003 Dec;38(6):1489-99.
[17]Hollands CM, Rivera-Pedrogo FJ, Gonzalez-Vallina R, et al. Heal exclusion for Byler's disease:an alternative surgical approach with promising early results for pruritus[J]. J Pediatr Surg 1998;33(2):220-4.
[1]岳茂兴.胃肠道功能障碍及衰竭的诊断和治疗[J].世界华人消化杂志,2002,10(1)：3-6
[2]邓丽静,康焰.肠黏膜屏障与保护[J].中国呼吸与危重监护杂志,2004,3(5)：327-328
[3]Kulinich LI, Fish NG, Mazitova OP, Dratvin SA, Birger MO.Using SIB and API kits to identify and biotype enterobacteria of different origin[J].J Hyg Epidemiol Microbiol Immunol.1987:31 (3):287-92.
[4]Phillips SB, Amsterdam D.API computer profiles:correlation of API 20E with API 10S[J].J Clin Microbiol.1977;6(6):645-6.
[5]Carlisle EM, Morowitz MJ.Pediatric surgery and the human microbiome[J].J Pediatr Surg.2011 Mar;46(3):577-84. doi:10.1016/j.jpedsurg.2010.12.018.
[6]Begley M, Gahan C G,Hill C.The interaction between bacteria and bile[J].FEMS Microbiol Rev,2005,29(4):625-651
[7]Sozen S, Topuz O, Uzun AS, Cetinkunar S, Das K.Prevention of bacterial translocation using glutamine and melatonin in small bowel ischemia and reperfusion in rats[J].Ann Ital Chir.2012;83(2):143-8.
[8]Mangell P, Thorlacius H, Syk I, Ahrne S, Molin G, Olsson C, Jeppsson B.Lactobacillus plantarum 299v does not reduce enteric bacteria or bacterial translocation in patients undergoing colon resection[J].Dig Dis Sci.2012 Jul;57(7):1915-24.
[9]Lundell L.Use of probiotics in abdominal surgery[J].Dig Dis.2011;29(6):570-3.
[10]乔治,黎沾良,李基业,陆连荣,吕艺,于勇,黎君友,孙丹.腹部外科手术后肠道细菌移位及肠道屏障的研究[J].中华急诊医学杂志,2004,13(10)：664-666.
[11]苏永辉,贾英斌,潘海燕,郭兆旺,谢玉研,张百萌.肝门阻断对大鼠肠道细菌移位和内毒素血症的影响[J].中山大学学报,2010,31(6)：867-871.
[12]Park JJ, Chung KY, Nam YS.Two-day fasting prior to intestinal ischemia-reperfusion injury on bacterial translocation in rats[J].J Invest Surg.2011;24(6):262-6.
[13]O'Boyle CJ,MacFie J,Mitchell CJ,et al.Microbiology of bacterial translocation in humans[J].Gut,1998,42:29-35
[14]梁力建李绍强关于胆肠吻合术一些问题的思考[J].中国实用外科杂 志.2004,24(1)：41-42.
[15]Madden JL, Chun JY, Kandalaft S, et al. Choledochoduo-denostomy:an unjustly maligned surgical procedure[J]. AmJ Surg.1970,119:45-54.
[16]钱礼,张启瑜,俞蔚明.胆肠吻合术后继发胆管炎的发病机制和各型胆肠吻合术的疗效分析[J].浙江医学,1983,5：1-7.
[17]曾宪九,张建希,汪忠镐,等.空肠Y型吻合后预防返流的进一步经验[J].中华外科杂志,1984,22：543-544.
[18]Luketic VA, Sanyal AJ. The current status of ursodeoxycholate in the treatment of chronic cholestatic liver disease[J]. Gastroenter-ologist,1994; 2:74-9.
[19]Wells CL, Jechorek RP, Erlandsen SL. Inhibitory effect of bile on bacterial invasion of enterocytes:possible mechanism for increased translocation associated with obstructive jaundice[J]. Crit. Care Med.1995; 23:301-7.
[20]刘建强,张志坚,王雯,林克荣,朱金照,林晴.胆汁酸对肝硬化大鼠肠道细菌移位和内毒素血症的影响[J].福建医科大学学报,2006,40(3)：231-236.
[21]Aldemir M, Geyik MF, Kokoglu OF, e t al. Effects of ursodeoxycholic acid, glutamine and polyclonal immunogl obu lins on bacterial translocation in common bile duct ligated rats[J].A N Z J Surg,2003,73(9):722-726.
[22]Ogat a Y, Nishi M, Nakayama H, e ta 1. Rol e of bile in in test inal barrier fun ct ion and it s in hibit ory ef feet on bact eri al t ran slocat ion in ob st ruct ive jaundice in rats [J]. J S urg Res,2003,115(1):18-23.
[23]DrydenL.Surgical site infection[J].NursStand.2012,4;27(13):59.
[24]Gagliardi AR, Fenech D, Eskicioglu C, Nathens AB, McLeod R.Factors influencing antibiotic prophylaxis for surgical site infection prevention in general surgery:a review of the literature [J]. Can J Surg.2009;52(6):481-9.
[25]朱会英,李艳春,向佩莹,王艳,许蔓春.肝胆外科手术部位感染目标性监测分析[J].中华医院感染学杂志,2012,,22(21)：4755-4757.
[1]Bird RP, McLellan EA. Bruce WR. Aberrant crypts, putative precancerous lesions, in the study of the role of diet in the aetiology of colon cancer[J]. Cancer Surv 1989; 8:189-200
[2]Pretlow TP, Barrow BJ, Ashton WS, O'Riordan MA, Pretlow TG, Jurcisek JA, Stellato TA. Aberrant crypts:putative pre-neoplastic foci in human colonic mucosa[J]. Cancer Res 1991;51:1564-1567
[3]Alrawi SJ, Schiff M, Carroll RE, Dayton M, Gibbs JF, Kulavlat M, Tan D, Berman K, Stoler DL, Anderson GR. Aberrant crypt foci[J].Anticancer Res.2006 Jan-Feb;26(1A):107-19.
[4]Sato T, Stange DE, Ferrante M, Vries RG, Van Es JH, Van den Brink S, Van Houdt WJ, Pronk A, Van Gorp J, Siersema PD, Clevers H.Long-term expansion of epithelial organoids from human colon, adenoma, adenocarcinoma, and Barrett's epithelium[J].Gastroenterology.2011 Nov;141(5):1762-72.
[5]Sikalidis AK, Fitch MD, Fleming SE.Diet Induced Obesity Increases the Risk of Colonic Tumorigenesis in Mice[J],Pathol Oncol Res.2013 Mar 28.
[6]Lin OS. Acquired risk factors for colorectal cancer[J].Methods Mol Biol. 2009;472:361-72.
[7]Ueyama Y, Monden Y, He XB, Lin CX, Momen MA, Mimura S, Umemoto A.Effects of bile acids on 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine-induced aberrant crypt foci and DNA adduct formation in the rat colon[J]. J Exp Clin Cancer Res. 2002;21(4):577-83.
[8]AltieriA,PelueehiC,TalaminiR,etal.Choleeysteetomy and the risk of colorectal cancer in Italy[J].Br J Cancer,2004,90(9):1753-1755.
[9]Laurie A.M.,Sutherland,Ranjana,P.Bird.The effect of chenodeoxycholic acid on the development of aberrant crypt foci in the rat colon[J]. Cancer Letters 1994,76:101-107.
[10]Kawabata K, T anaka T, Murakami T, Okada T, Murai h, Yamamoto T, hara A, Shimizu M, Yamada Y, Matsunaga K, Kuno T, Yoshimi n, Sugie S and Mori h. Dietary prevention of azoxymethane-induced colon carcinogenesis with rice-germ in F344 rats[J]. Carcinogenesis 1999Nov;20(11):2109-2115.
[11]Bernstein, C., Holubec, H., Bhattacharyya, A.K., Nguyen. H., Payne, C.M., Zaitlin, B..Bernstein, H. Carcinogenicity of deoxycholate. a secondary bile acid[J]. Arch.Toxicol.2011.85.863-871.
[12]Butler. L.M., Wang, R.. Koh. W.P., Stern, M.C.. Yuan, J.M., Yu. M.C.. Marine n-3 and saturated fatty acids in relation to risk of colorectal cancer in Singapore Chinese: a prospective study[J]. Int. J. Cancer,2009.124,678-686.
[13]Carroll, K.K.,. Dietary fats and cancer[J]. Am. J. Clin. Nutr.1991,53,1064S-1067S.
[14]Reddy. B.S., Diet and excretion of bile acids[J]. Cancer Res.1981.41,3766-3768.
[15]Reddy, B.S., Hanson, D., Mangat, S., Mathews, L., Sbaschnig, M., Sharma, C., Simi, B. Effect of high-fat, high-beef diet and of mode of cooking of beef in the diet on fecal bacterial enzymes and fecal bile acids and neutral sterols[J]. J. Nutr.1980.110,1880-1887.
[16]Bayerdorffer, E., Mannes, G.A., Ochsenkuhn, T., Dirschedl, P., Wiebecke, B.,Paumgartner, G., Unconjugated secondary bile acids in the serum of patients with colorectal adenomas[J]. Gut,1995.36,268-273.
[17]Reddy, B.S., Wynder, EX.. Metabolic epidemiology of colon cancer. Fecal bile acids and neutral sterols in colon cancer patients and patients with adenomatous polyps[J]. Cancer,1977,39,2533-2539.
[18]Tong, J.L., Ran, Z.H., Shen, J., Fan, G.Q., Xiao, S.D. Association between fecal bile acids and colorectal cancer:a meta-analysis of observational studies. Yonsei Med. J. 2008,49,792-803.
[19]Bernstein, C., Holubec, H., Bhattacharyya, A.K., Nguyen, H., Payne, C.M., Zaitlin, B.,Bernstein, H.. Carcinogenicity of deoxycholate, a secondary bile acid[J]. Arch.Toxicol.2011,85,863-871.
[20]Debruyne, P.R., Bruyneel, E.A., Li, X., Zimber, A., Gespach, C, Mareel, M.M., The role of bile acids in carcinogenesis[J]. Mutat. Res.2001,480-481,359-369.
[21]STEVENSRG,SWEDEH,ROSENBERGDW.EPideology of colonic aberrant crypt foci:review and analysis of existing studies[J].CancerLett,2007,252(2):171-183
[22]Bird RP.GOOD CK.The significance of aberrant crypt foci in understanding the pathogenesis of colon cancer[J].ToxicolLett,2000,112-113:395-402
[23]Orlando, F.A.;Tan, D.; Baltodano, J.D.; Khoury, T.; Gibbs, J.F.; Hassid,V.J.; Ahmed,B.H.;Alrawi,S.J. Aberrant crypt foci as precursors in colorectal cancer progression[J]. J. Surg. Oncol.2008,98,207-213.
[24]Humphries A, Wright NA.Colonic crypt organization and tumorigenesis[J]. Nat Rev Cancer.2008,8(6):415-24.
[25]Seraj MJ,UmemotoA,KajikawaA,MimuraS,KinouchiT,OhnishiY,MondenY.Effects of dietary bile acids on formation of azoxymethane-induced aberrant crypt foci in F344 rats[J].Cancer Lett 1997,115:97-103.
[26]Lin C,Umemoto A,Jabed MS,Mimura S,Monden Y.Effect of bile acids on formation of azoxymethane-induced aberrant crypt foci in colostomized F344 rat colon[J].Cancer Lett 169:121-126,2001
[27]Momen MA, Monden Y, Houchi H, Umemoto A. Effect of ursodeoxycholic acid on azoxymethane-induced Aberrant crypt foci formation in rat colon:in vitro potential role of intracellular Ca2+[J].J Med Invest.2002 Feb;49(1-2):67-73.
[28]Serfaty, L., Bissonnette, M., Poupon, R.,2010. Ursodeoxycholic acid and chemoprevention of colorectal cancer[J]. Gastroenterol. Clin. Biol.34,516-522.
[29]Tung, B.Y., Emond, M.J., Haggitt, R.C., Bronner, M.P., Kimmey, M.B., Kowdley, K.V.,Brentnall, T.A.,2001. Ursodiol use is associated with lower prevalence of colonic neoplasia in patients with ulcerative colitis and primary sclerosing cholangitis[J].Ann.Int.Med.134,89-95
[30]Choi HJ,Jung ZK,Kim SS,et al.Proliferating cell nuclear antigen expression and its relationship to malignancy potential in invasive colorectal carcinomas[J].Dis Colon Rectum,1997,40(1):51-59.
[31]吴成秋,陈雯,张桥,等.二甲肼诱导大鼠肠癌过程中增殖细胞核抗原的表达[J].中国癌症杂志,2000,10(6)：553.
[32]Maeda K, Chung Y, Onoda N, et al. Proliferating cell nuclear antigen labeling index of preoperative biopsy specimens in gastric carcinoma with special reference to prognosis [J]. Cancer,1994,73(3):528.
[1]Bertalan V, Szepes A, Lonovics J. Madacsy L.Assessment of the reproducibility of quantitative hepatobiliary scintigraphy (QHBS) in patients with sphincter of Oddi dysfunction (SOD)--inappropriate method or intermittent disease[J]?Hepatogastroenterology.2006 Mar-Apr;53(68):160-5.
[2]Thomsen MK, Lange A, Frokiaer J.The role of hepatobiliary scintigraphy in neonates with persistant jaundice[J].Ugeskr Laeger.2005 Sep 26;167(39):3675-8.
[3]Toftdahl DB, Hojgaard L, Winkler K.Dynamic cholescintigraphy:induction and description of gallbladder emptying[J].J Nucl Med.1996 Feb;37(2):261-6.
[4]李龙,张金山,张军,等.胆囊结肠吻合治疗进行性家族性肝内胆汁淤积症的探讨[J].中华小儿外科杂志,2011,32(10)：31-35.
[5]Davis AR, Rosenthal P, Newman TB. Nontransplant surgical interventions in progressive familial intrahepatic cholestasis[J]. Journal of Pediatric Surgery,2009,44(4):821-827.
[6]Ron Rees Davies, BVSc, CertZooMed, etal. Rabbit gastrointestinal physiology[J].Vet Clin Exot Anim,2003,6:139-153.
[7]毛一雷,张涛,桑新亭,等.应用单光子发射型计算机断层显像评价剩余肝功能的动物实验研究[J].中华外科杂志,2007,45(9)：609-612.
[8]Raithel M, Nagel A, Maiss J, Wildner D, Hagel AF, Braun S, Diebel H, Hahn EG.Conventional endoscopic retrograde cholangiopancreaticography vs the Olympus V-scope system[J].World J Gastroenterol.2013 Mar 28;19(12):1936-42. doi:10.3748/wjg.vl9.i12.1936.
[9]Uchiyama K, Kuniyasu Y, Higashi ST, Shen Y, Niio Y, Hasebe S, Matsuoka S, Shima H, Shinohara H, Takizawa K, Obuchi M, Honda M, Hirata N.Precision of the gallbladder ejection fraction obtained with Tc-99m-pyridoxyl-5-methyl-tryptophan (99mTc-PMT) hepatobiliary scintigraphy as compared with the contraction ratio in three-dimensional computed tomography [J]. Ann Nucl Med.1997 May;1(2):123-8.
[10]许国铭.胆道运动功能检测及临床意义[J].北京医学,1998,20(增刊)：11-15;
[11]Santhosh S, Mittal BR, Arun S, Sood A, Bhattacharya A, Kochhar R.Quantitative cholescintigraphy with fatty meal in the diagnosis of sphincter of Oddi dysfunction and acalculous cholecystopathy[J].Indian J Gastroenterol.2012 Jul;31(4):186-90. Epub 2012 Sep 2.
[12]Shimotakahara A, Yamataka A, Yanai T, Kobayashi H. Okazaki T, Lane GJ, Miyano T. Roux-en-Y hepaticojejunostomy or hepaticoduodenostomy for biliary reconstruction during the surgical treatment of choledochal cyst:which is better[J]?Pediatr Surg Int.2005 Jan;21(1):5-7.
[13]Felder SI. Menon VG, Nissen NN, Margulies DR, Lo S, Colquhoun SD. Hepaticojejunostomy Using Short-Limb Roux-en-Y Reconstruction[J]. JAMA Surg.2013 Mar 1;148(3):253-7. doi:10.1001/jamasurg.2013.601.
[14]Mei Diao, Long Li, Jin-Zhe Zhang, etal. A shorter loop in Roux-Y hepatojejunostomy reconstruction for choledochal cysts is equally effective: preliminary results of a prospective randomized study[J]. Journal of Pediatric Surgery,2010,45:845-847.
[15]Gustavsson S, Ilstrup DM, Morrison P, Kelly KA. Roux-en-Y stasis syndrome after gastrectomy[J]. Am J Surg,1988,155:490-494.
[16]Robson Azevedo Dutra,Wemberton Martins Araujo,Jose Ivan de Andrade. The effects of Roux-en-Y limb length on gastric emptying and enterogastric reflux in rats. Acta Cirurgica Brasileira,2008,23(2):179-183.
[17]谭毓铨,等.论胆肠吻合术[J].中国普通外科杂志,2005,14(8)：564-566.
[18]梁力建,李绍强.关于胆肠吻合术一些问题的思考[J].中国实用外科杂志,2004,24(1)：41-42.
[19]Onodera Y,Takahashi K,Sugai Y,et al.Evaluation of the liver uptake rate measured by 99mTc-GSA SPECT to assess liver function[J].Kaku Igaku,1999,36(1):37-44.
[1]Emerick KM, Elias MS. Melin-Aldana H. et al.Bile composition in alagille syndrome and PFIC patients having partial external biliary diversion[J].BMC Gastroenterol,2008,8:47-52.
[2]MelterM,RodeckB,KardorffR.Progressive familial intrahepatic cholestasis partial bilia ry diversion normalizes serum lipids and improves growth in noncirrhotic patients[J]. Am J Gastroenterol,2000,95(12):3522-3528.
[3]Arnell H, Papadogiannakis N, Zemack H, et al. Follow-up in children with progressive familial intrahepatic cholestasis after partial external biliary diversion [J]. J Pediatr Gastroenterol Nutr,2010,51(4):494-499.
[4]Kalicinski PJ, Ismail H, Jankowska I, et al. Surgical treatment of progressive familial intrahepatic cholestasis:comparison of partial external biliary diversion and ileal bypass[J]. Eur J Pediatr Surg,2003,13:307-311.
[5]Bustorff-Silva J, Sbraggia Neto L, Olimpio H, et al. Partial internal biliary diversion through a cholecystojejunocolonic anastomosis-a novel surgical approach for patients with progressive familial intrahepatic cholestasis:a preliminary report[J]. Pediatr Surg,2007,42(8):1337-1340.
[6]Gun F, Erginel B, Durmaz O, et al. An outstanding non-transplant surgical intervention in progressive familial intrahepatic cholestasis:partial internal biliary diversion[J]. Pediatr Surg Int,2010,26(8):831-834.
[7]Ganesh R, Suresh N, Sathiyasekeran M, et al. Partial internal biliary diversion:a solution for intractable pruritus in progressive familial intrahepatic cholestasis type 1[J]. Saudi J Gastroenterol,2011,17:212-214.
[8]Schukfeh N, Metzelder ML, Petersen C, et al. Normalization of serum bile acids after partial external biliary diversion indicates an excellent long-term outcome in children with progressive familial intrahepatic cholestasis[J]. J Pediatr Surg,2012,47:501-505.
[9]Yang H, Porte RJ, Verkade HJ, et al. Partial external biliary diversion in children with progressive familial intrahepatic cholestasis and Alagille disease[J].J Pediatr Gastroenterol Nutr,2009,49:216-221.
[10]李龙,张金山,张军,等.胆囊结肠吻合治疗进行性家族性肝内胆汁淤积症的探讨[J].中华小儿外科杂志,2011,32(10)：31-35.
[11]Davis AR, Rosenthal P, Newman TB. Nontransplant surgical interventions in progressive familial intrahepatic cholestasis[J]. J Pediatr Surg,2009,44(4):821-827.
[12]Diao M, Li L, Zhang JS, Ye M,et al. Laparoscopic cholecystocolostomy:a novel surgical approach for the treatment of progressive familial intrahepatic cholestasis [J].Ann Surg,2012, Nov 26..[Epub ahead of print].
[1]刘垚,李龙.进行性家族性肝内胆汁淤积症的治疗进展[J].中华小儿外科杂志,2012,33(1)：59-61.
[2]Mochizuki K, Obatake M, Takatsuki M, Nakatomi A, Hayashi T, Okudaira S, Eguchi S. Partial internal biliary diversion for patients with progressive familial intrahepatic cholestasis type 1[J]. Pediatr Surg Int.2012;28(1):51-4.
[3]Gun F, Erginel B,Durmaz O,Sokucii S,Salman T,CelikA.An outstanding non-transplant surgical intervention in progressive familial intrahepatic cholestasis: partial internal biliary diversion[J]. Pediatr Surg Int,2010,26(8):831-4.
[4]李龙,张金山,张军,等.胆囊结肠吻合治疗进行性家族性肝内胆汁淤积症的探讨[J].中华小儿外科杂志,2011,32(10)：31-35.
[5]Whitington PF, Whitington GL. Partial external diversion of bile for the treatment of intractable pruritus associated with intrahepatic cholestasis[J]. Gastroenterology 1988;95(1):130-6.
[6]Bustorff-Silva J, Sbraggia Neto L, Olimpio H, et al. Partial internal biliary diversion through a cholecystojejunocolonic anastomosis-a novel surgical approach for patients with progressive familial intrahepatic cholestasis:a preliminary report [J]. J Pediatr Surg 2007; 42(8):1337-40.
[7]Metzelder ML, Bottlander M, Melter M, et al. Laparoscopic partial external biliary diversion procedure in progressive familial intrahepatic cholestasis:a new approach[J]. Surg Endosc 2005; 19(12):1641-3.
[8]Sharma D, Shah UH, Sibal A, Chowdhary SK. Cholecystoappendicostomy for progressive familial intrahepatic cholestasis[J]. Indian Pediatr,2010,47(7):626-8.
[9]Hollands CM. Rivera-Pedrogo FJ. Gonzalez-Vallina R, et al. Heal exclusion for Byler's disease:an alternative surgical approach with promising early results for pruritus[J]. J Pediatr Surg 1998;33(2):220-4.
[10]Kurbegov AC, Setchell KD, Haas JE, et al. Biliary diversion for progressive familial intrahepatic cholestasis:improved liver morphology and bile acid profile[J]. Gastroenterology 2003; 125(4):1227-34.
[11]Yang H, Porte RJ, Verkade HJ, De Langen ZJ, Hulscher JB. Follow-up in children with progressive familial intrahepatic cholestasis after partial external biliary diversion [J]J Pediatr Gastroenterol Nutr,2009,49(2):216-21.
[12]Ng VL, Ryckman FC, Porta G, et al. Long-term outcome after partial external biliary diversion for intractable pruritus in patients with intrahepatic cholestasis[J]. J Pediatr Gastroenterol Nutr 2000;30(2):152-6.
[13]Ekinci S, Karnak I, Giirakan F, Yuce A, Senocak ME, Cahit Tanyel F, Buyukpamukcu N. Partial External Biliary Diversion for the Treatment of Intractable Pruritus in Children with Progressive Familial Intrahepatic Cholestasis:Report of Two Cases [J]. Surg Today,2008;38(8):726-30.
[14]Schukfeh N, Metzelder ML, Petersen C, Reismann M, Pfister ED, Ure BM, Kuebler JF. Normalization of serum bile acids after partial external biliary diversion indicates an excellent long-term outcome in children with progressive familial intrahepatic cholestasis[J]. J Pediatr Surg.2012,47(3):501-5.
[15]Emond JC, Whitington PF. Selective surgical management of progressive familial intrahepatic cholestasis (Byler's disease). J Pediatr Surg 1995:30(12):1635-41.
[16]Arnell H, Bergdahl S, Papadogiannakis N, Nemeth A, Fischler B. Preoperative observations and short-term outcome after partial external biliary diversion in 13 patients with progressive familial intrahepatic cholestasis [J]. J Pediatr Surg.2008;43(7):1312-20.