Le Blanc-Louvry I, Ducrotté P, Peillon C, Michel P, Chiron A, Denis P
Digestive Tract Research Group, Rouen University Hospital, France.
J Am Coll Surg. 2000 Apr;190(4):408-17. doi: 10.1016/s1072-7515(99)00293-8.
The aims of this study were to compare Roux-en-Y limb motor patterns after total or distal gastrectomy, and to identify possible motor differences between symptomatic and asymptomatic patients. The usefulness of preoperative recording was also investigated.
Sixteen patients were enrolled in the study, 10 patients after total gastrectomy (TG group) and 6 patients after distal gastrectomy (DG group). In 6 of 10 patients in the TG group, recordings were obtained before and after operation. Manometric recordings in the limb lasted 6 hours in all patients, 3 hours during fasting, and 3 hours after a 750-kcal meal. An intravenous injection of trimebutine (100-mg i.v.) was systematically administered at the end of each recording session. Motor results of the patients were compared with those obtained in the intact jejunum of 20 healthy controls.
After operation, when patients were compared with controls, phase III (ie, regular activity of the migrating motor complex) was more frequent and more often incompletely propagated (5 of 16 patients versus 1 of 20 controls, unadjusted p < 0.05) and was significantly slower (p < 0.01 versus controls). Intravenous trimebutine induced phase III in 12 of 16 patients within a mean of 8.8 +/- 1 (SEM) minutes, longer than in controls (delay < 2 minutes). The fed pattern was shorter than in controls in both TG and DG groups, and the postprandial area under the curve during successive 30-minute periods was reduced in the DG group compared with controls (p < 0.01). In patients investigated before gastrectomy, motor parameters were not different from those of controls. Surgery resulted in an increased number of phase IIIs and a decreased migration velocity (p < 0.01) of phase III, a longer delay in response after trimebutine (p < 0.0001), and a reduced postprandial motor response (p < 0.01). After the operation, 4 of 10 patients in the TG group and 5 of 6 patients in the DG group were symptomatic. Symptomatic patients had slower and more often incompletely propagated (p < 0.01) phase III compared with asymptomatic patients.
Roux-en-Y limb reconstruction mainly disturbs phase III propagation and the motor response to a meal. Motor changes are more marked after DG than after TG. Disturbed phase III propagation is the main difference between symptomatic and asymptomatic patients. Successful induction of phase III with trimebutine after gastrectomy and Roux-en-Y reconstruction indicates maintenance of encephalinergic mechanisms.
本研究旨在比较全胃或远端胃切除术后Roux-en-Y肠袢的运动模式，并确定有症状和无症状患者之间可能存在的运动差异。还研究了术前记录的有用性。
16例患者纳入本研究，其中10例接受全胃切除术（TG组），6例接受远端胃切除术（DG组）。TG组10例患者中有6例在手术前后进行了记录。所有患者的肠袢测压记录持续6小时，禁食期3小时，进食750千卡餐后3小时。在每次记录结束时系统地静脉注射曲美布汀（100毫克静脉注射）。将患者的运动结果与20例健康对照者完整空肠的运动结果进行比较。
术后，与对照组相比，患者的Ⅲ期（即移行运动复合波的规则活动）更频繁且更常传播不完全（16例患者中的5例与20例对照者中的1例，未校正p<0.05），且明显更慢（与对照组相比p<0.01）。静脉注射曲美布汀后，16例患者中有12例在平均8.8±1（SEM）分钟内诱导出Ⅲ期，比对照组更长（延迟<2分钟）。TG组和DG组的进食模式均短于对照组，且DG组与对照组相比，连续30分钟期间餐后曲线下面积减小（p<0.01）。在胃切除术前接受检查的患者中，运动参数与对照组无差异。手术导致Ⅲ期数量增加，Ⅲ期移行速度降低（p<0.01），曲美布汀后反应延迟更长（p<0.0001），餐后运动反应降低（p<0.01）。术后，TG组10例患者中有4例，DG组6例患者中有5例出现症状。有症状患者与无症状患者相比，Ⅲ期更慢且更常传播不完全（p<0.01）。
Roux-en-Y肠袢重建主要干扰Ⅲ期传播和对进食的运动反应。DG术后的运动变化比TG术后更明显。Ⅲ期传播受干扰是有症状和无症状患者之间的主要差异。胃切除术后用曲美布汀成功诱导Ⅲ期以及Roux-en-Y重建表明脑啡肽能机制得以维持。
