Tsukamoto M, Enjoji A, Ura K, Kanematsu T
Department of Surgery II, Nagasaki University School of Medicine, Nagasaki, Japan.
Neurogastroenterol Motil. 2000 Feb;12(1):23-31. doi: 10.1046/j.1365-2982.2000.00179.x.
Many reports have been made on gallbladder dysfunction after gastric surgery. We reported that the gallbladder contractions were abolished after antrectomy. Our hypothesis is that preservation of the neural connection along gastric vessels maintains normal gallbladder function during fasting after antrectomy. Six dogs underwent antrectomy with preservation of the extrinsic nerves and six other dogs underwent conventional antrectomy with dissection of the extrinsic nerves and vessels. Laparotomy alone was performed on another six control dogs. Motor activities of the gallbladder and upper gastrointestinal tract were recorded by strain gauges in conscious dogs. Motilin and CCK-OP were used for pharmacological interventions. In conventional antrectomy, the amplitudes of the cyclic motor activity of the gallbladder and the stomach during fasting were significantly reduced, while this activity was maintained in dogs when extrinsic nerves were preserved. The coordination of the motor activity among the gallbladder, stomach and the duodenum was not impaired in the dogs when extrinsic nerves were preserved. The contractions of the gallbladder induced by exogenous motilin were reduced significantly in conventional antrectomy. Therefore, the preserved neural connection along the gastric vessels maintains normal gallbladder function in the fasting state even after distal gastrectomy.
已有许多关于胃手术后胆囊功能障碍的报道。我们曾报道过，胃窦切除术后胆囊收缩消失。我们的假设是，保留沿胃血管的神经连接可在胃窦切除术后禁食期间维持胆囊的正常功能。6只狗接受了保留外在神经的胃窦切除术，另外6只狗接受了切断外在神经和血管的传统胃窦切除术。另外6只对照狗仅接受剖腹手术。通过应变片记录清醒狗的胆囊和上消化道的运动活性。使用胃动素和CCK-OP进行药物干预。在传统胃窦切除术中，禁食期间胆囊和胃的周期性运动活性幅度显著降低，而保留外在神经的狗中该活性得以维持。保留外在神经时，狗的胆囊、胃和十二指肠之间的运动活性协调性未受损。在传统胃窦切除术中，外源性胃动素诱导的胆囊收缩显著减弱。因此，即使在远端胃切除术后，沿胃血管保留的神经连接仍可在禁食状态下维持胆囊的正常功能。
