Nabae Toshinaga, Yokohata Kazunori, Otsuka Takao, Inoue Ken, Yamaguchi Koji, Chijiiwa Kazuo, Tanaka Masao
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Ann Surg. 2002 Jul;236(1):98-104. doi: 10.1097/00000658-200207000-00015.
To evaluate the effects of truncal vagotomy at the diaphragmatic level on the sphincter of Oddi (SO) motility.
Cholelithiasis is a well-known late complication after gastrectomy and/or vagotomy. The mechanism of gallstone formation is only partly understood, and few studies address the effects of vagotomy on SO cyclic motility in conscious subjects.
In conscious dogs, SO motility was recorded by retrograde infusion manometry through a duodenal cannula before and after bilateral truncal vagotomy at the diaphragmatic level. Effects of cholecystokinin-octapeptide and feeding were also evaluated before and after vagotomy.
SO cyclic motility and the gastroduodenal migrating motor complex continued to occur during postvagotomy fasting. Intermittent inhibitions of the SO and duodenal contractions disappeared during phase 3 of the migrating motor complex. SO basal pressure significantly decreased, whereas the amplitude significantly increased. Cholecystokinin-octapeptide inhibited SO contractions before and after vagotomy. The amplitude of SO contractions increased and their frequency decreased after feeding; however, these effects disappeared after vagotomy.
SO cyclic motility and the effects of feeding change after truncal vagotomy at the diaphragmatic level. These facts may at least partly explain gallstone formation after gastric surgery and/or vagotomy.
评估膈水平切断迷走神经干对Oddi括约肌(SO)运动的影响。
胆石症是胃切除术和/或迷走神经切断术后一种众所周知的晚期并发症。胆石形成的机制仅部分被理解,很少有研究探讨迷走神经切断术对清醒受试者SO周期性运动的影响。
在清醒犬中,通过十二指肠插管逆行灌注测压法记录膈水平双侧切断迷走神经干前后的SO运动。还评估了迷走神经切断术前后胆囊收缩素八肽和进食的影响。
迷走神经切断术后禁食期间,SO周期性运动和胃十二指肠移行性运动复合波持续存在。移行性运动复合波第3期期间,SO和十二指肠收缩的间歇性抑制消失。SO基础压力显著降低,而幅度显著增加。胆囊收缩素八肽在迷走神经切断术前后均抑制SO收缩。进食后SO收缩幅度增加,频率降低;然而,这些效应在迷走神经切断术后消失。
膈水平切断迷走神经干后,SO周期性运动和进食的影响发生改变。这些事实可能至少部分解释了胃手术和/或迷走神经切断术后胆石的形成。