DYNAMICS OF CHANGES IN THE VASCULAR BED OF THE DUODENUM IN CONDITIONS OF OBSTRUCTIVE CHOLESTASIS IN COMBINATION WITH DECOMPRESSION OF THE BILIARY TRACT AND THE USE OF ENTEROSORBENTS
DOI:
https://doi.org/10.11603/1811-2471.2023.v.i3.14079Keywords:
obstructive cholestasis, duodenum, architectonics, morphometry, enterosorbentAbstract
SUMMARY. Obstructive cholestasis, creating an intrahepatic block, is accompanied by an increase in pressure in the portal system and the development of portal hypertension, which significantly affects the vascular bed of the duodenum. The dynamics of changes in the channels of the duodenum in this pathology have not been studied enough.
The aim – to analyze the effectiveness of the use of enterosorbents in combination with choledochoduodenostomy and their effect on functional changes in the vascular bed of the duodenum in obstructive cholestasis.
Material and Methods. From the first day of decompression of the biliary tract, there is an increase in the level of endogenous intoxication, which has a significant effect on the restoration of functional and structural changes in the vascular bed of the duodenum, therefore, in order to reduce the level of intoxication and improve the recovery processes, we studied 23 experimental animals (sexually mature Vietnamese male pigs breed) with 28-day obturation cholestasis, to which 7 days before decompression of the biliary tract, an enterosorbent of the carboline group was added to the diet at the rate of 0.7 g/kg of the animal's weight. On the 3rd day after surgical decompression, the vascular bed of the duodenum was examined in 3 experimental animals, after 7 days – in 3 animals, after 14 days – in 4 pigs, after 28 days – in 4 animals. In this study, we used such methods as x-ray and the analysis of the architecture of the vascular bed of the duodenum was carried out according to the unified method proposed by K. A. Shoshenko to study the stereometric organization of vascular beds, the type of branching was determined on radiographs, the diameters, the length of the "vascular tee", the main and subsidiary branches, the angles of departure of the latter from the main trunks were measured. The obtained digital material was processed by the method of variational statistics using the Student's test, and in other cases - using the Mann–Whitney U-test. The difference between the average values was considered reliable when the probability of the alternative hypothesis was at least 95 %.
Conclusions. Therefore, the conducted studies and the obtained results indicate that the correction of obstructive cholestasis by decompression of the biliary tract in the combined use of enterosorbents has a positive effect on the morphogenesis of the duodenum. After complex correction of 28-day obturation cholestasis, the morphological indicators of arterial trunks of the I, II, III, IV, V orders did not statistically significantly differ from the same quantitative values of control groups of experimental animals. The Kernoghan index of the small-caliber arteries of the duodenum under these experimental conditions did not significantly differ from the control values. At the same time, the condition of the hemomicrocirculatory channel significantly improved. Thus, the diameter of arterioles, hemocapillaries, and venules in the mucous membrane of the upper part of the duodenum was equal to the input index to the simulated pathology.
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