Bracci F, Matarazzo E, Mosiello G, Caione P, Cianchi D, Ponticelli A
Department of Pediatric Surgery, Bambino Gesú Children Hospital, Rome, Italy.
J Pediatr Surg. 2001 Aug;36(8):1157-9. doi: 10.1053/jpsu.2001.25735.
BACKGROUND/PURPOSE: Gastric resection is an infrequent surgical procedure in childhood. However, the use of the stomach for bladder augmentation and substitution is well documented. Partial gastrectomy performed in gastrocystoplasty (GCP) involves the greater curvature of the stomach, the same area in which gastric pace-maker cells are known to be placed. The aim of this study was to assess, by electrogastrography (EGG), if subtotal gastric resection can alter gastric motility in children submitted to partial gastrectomy for GCP.
Gastric electrical activity (GEA) was evaluated in 25 children using EGG: 10 patients (4 boys, 6 girls; mean age, 11.6 years) previously submitted to GCP, and 15 normal subjects (12 boys, 3 girls; mean age, 8.62 +/- 2.77 years) as controls. All patients were submitted to cutaneous EGG; recording GEA for 30 minutes before and after a standard test meal. The percentage of 3 cycles per minute (3CPM), bradygastria, tachygastria, DFIC (dominant frequency instability coefficient), DPIC (dominant power instability coefficient), PDP (period dominant power), PDF (period dominant frequency) were recorded and analyzed using Wilcoxon matched-pair test. Data were considered statistically significant if P <.05.
Normal subjects as well as operated patients showed a statistically significant difference in bradygastria (P =.05), PDP and PDF (P =.05) percentage, comparing pre versus postprandial period. In the normal group, 3CPM (P =.0012) and DFIC (P =.0008) were statistically different between the pre- and postprandial period. Patients who underwent GCP did not show any statistically significant difference in 3CPM and DFIC pre- and postprandial.
In normal subjects, GEA showed a complete variation after the meal, whereas in operated patients GEA was impaired and only partially modified after the meal. This observation suggests that in patients with gastric resection, adaptation of the stomach to food ingestion is present but incomplete with respect to normal subjects; it can be caused by surgical removal of the pace-maker cells of the greater curvature. For this reason a follow-up analysis of gastric function is recommended for all patients undergoing GCP.
背景/目的：胃切除术在儿童时期是一种不常见的外科手术。然而，利用胃进行膀胱扩大术和替代术已有充分的文献记载。胃囊肿成形术（GCP）中进行的部分胃切除术涉及胃大弯，而胃起搏细胞已知就位于该区域。本研究的目的是通过胃电图（EGG）评估，对于因GCP接受部分胃切除术的儿童，胃次全切除是否会改变其胃动力。
使用EGG对25名儿童的胃电活动（GEA）进行评估：10例患者（4名男孩，6名女孩；平均年龄11.6岁）之前接受过GCP手术，15名正常受试者（12名男孩，3名女孩；平均年龄8.62±2.77岁）作为对照。所有患者均接受皮肤EGG检查；在标准试餐前后记录30分钟的GEA。记录每分钟3个周期（3CPM）的百分比、胃动过缓、胃动过速、DFIC（主导频率不稳定系数）、DPIC（主导功率不稳定系数）、PDP（周期主导功率）、PDF（周期主导频率），并使用Wilcoxon配对检验进行分析。如果P<.05，则数据被认为具有统计学意义。
正常受试者和手术患者在餐后胃动过缓（P =.05）、PDP和PDF（P =.05）百分比方面，餐前和餐后比较均显示出统计学显著差异。在正常组中，餐前和餐后3CPM（P =.0012）和DFIC（P =.0008）存在统计学差异。接受GCP手术的患者在餐前和餐后3CPM和DFIC方面未显示任何统计学显著差异。
在正常受试者中，GEA在餐后显示出完全变化，而在手术患者中，GEA受损，餐后仅部分改变。这一观察结果表明，在胃切除患者中，胃对食物摄入的适应性存在，但相对于正常受试者而言并不完全；这可能是由于胃大弯起搏细胞的手术切除所致。因此，建议对所有接受GCP手术的患者进行胃功能的随访分析。
