Gutschow C A, Collard J M, Romagnoli R, Michel J M, Salizzoni M, Hölscher A H
Department of Surgery, University of Louvain, Brussels, Belgium.
Ann Thorac Surg. 2001 Jun;71(6):1786-91. doi: 10.1016/s0003-4975(01)02535-8.
Both the supine position and the existence of a gastric drainage procedure are suspected to promote reflux of duodenal juice into the denervated intrathoracic stomach. Erythromycin has been shown to weaken pyloric resistance to gastric outflow and to enhance antral motility, gastric emptying, and gallbladder contractility.
The presence of bile in the gastric transplant of 79 patients was monitored over a 24-hour period with use of the Bilitec 2000 optoelectronic device 3 to 195 months after subtotal esophagectomy. Ten patients were reinvestigated after a 3-year period. Five groups were studied: group I: n = 12, no gastric drainage, never given erythromycin, group 2: n = 40, gastric drainage, never given erythromycin, group 3: n = 7, no gastric drainage, given erythromycin, group 4: n = 13, gastric drainage, given erythromycin, and group 5: n = 7, no longer given erythromycin (with or without gastric drainage). The percentage of time gastric bile absorbance was more than 0.25 was calculated for the total, supine, and upright periods of recording in reference to data from 25 healthy volunteers.
The Bilitec test was pathologic in 9 of the 12 patients of group 1 whereas it was normal in three. Gastric exposure to bile was longer in group I patients than in controls for the total (p = 0.012) and supine (0.036) periods, but the difference did not reach statistical significance for the upright period (p = 0.080). Bile exposure in group 4 did not significantly differ from controls (total: p = 0.701; supine: p = 0.124; upright: p = 0.712). Bile exposure for the total period did not significantly differ whether patients were taking erythromycin or the drug had been discontinued at the time of the study (p = 0.234); and it tended to decrease with time in patients investigated twice (p = 0.046).
Gastric exposure to bile after truncal vagotomy and transposition of the stomach up to the neck is pathologic in three quarters of patients. It is more marked in the supine than in the upright position and tends to decrease with time. The addition of a gastric drainage procedure in combination with erythromycin therapy tends to normalize gastric exposure to bile. The effects of erythromycin may persist after discontinuation of the drug.
仰卧位和胃引流操作均被怀疑会促使十二指肠液反流至去神经支配的胸腔内胃。已证实红霉素可减弱幽门对胃流出道的阻力，并增强胃窦蠕动、胃排空及胆囊收缩力。
在79例患者行食管次全切除术后3至195个月期间，使用Bilitec 2000光电设备对其胃移植体中的胆汁存在情况进行24小时监测。10例患者在3年后再次接受检查。研究分为五组：第一组：n = 12，未行胃引流，从未使用过红霉素；第二组：n = 40，行胃引流，从未使用过红霉素；第三组：n = 7，未行胃引流，使用过红霉素；第四组：n = 13，行胃引流，使用过红霉素；第五组：n = 7，不再使用红霉素（无论有无胃引流）。参照25名健康志愿者的数据，计算记录的总时间段、仰卧位时间段和直立位时间段内胃胆汁吸光度大于0.25的时间百分比。
第一组12例患者中有9例Bilitec检测结果异常，3例正常。第一组患者胃内胆汁暴露时间在总时间段（p = 0.012）和仰卧位时间段（0.036）均长于对照组，但在直立位时间段差异无统计学意义（p = 0.080）。第四组的胆汁暴露情况与对照组无显著差异（总时间段：p = 0.701；仰卧位：p = 0.124；直立位：p = 0.712）。无论患者在研究时正在服用红霉素还是已停药，总时间段内的胆汁暴露情况均无显著差异（p = 0.234）；在接受两次检查的患者中，胆汁暴露情况有随时间减少的趋势（p = 0.046）。
在胃迷走神经切断术及胃上提至颈部术后，四分之三的患者胃内胆汁暴露情况异常。仰卧位时比直立位更明显，且有随时间减少的趋势。胃引流操作联合红霉素治疗倾向于使胃内胆汁暴露情况恢复正常。停药后红霉素的作用可能仍会持续。
