Dahm K, Eichfuss H P, Knipper A, Mitschke H
Z Gastroenterol. 1977 Jan;15(1):9-20.
Different types of duodenal by-pass operations with and without duodenogastric reflux were performed on 54 male Wistar rats. The results of our investigation show that following duodenal by-pass with reflux peptic anastomotic ulcer regularly occurs. The constant reflux of bile and pancreas juice is the most important aetiologic factor in the development of ulcer in the vicinity of the anastomosis between the stomach and small intestine. Stasis in the by-passed duodenum (afferent loop syndrome) promotes ulcerogenic action of reflux. In the absence of the pylorus the effects of reflux and stasis potentiate, resulting in a high frequency of ulcer (greater than 90%). With intact pylorus the incidence is low. Duodenogastric reflux prevents hydrochloric acid secretion significantly (p less than o,o1); hydrochloric acid thus plays a minor role in the development of experimental anastomotic ulcer of the rat. -- In considering the prophylaxis against anastomotic ulcer, these findings support the claim of avoiding surgical techniques involving duodenal by-pass and reflux (Billroth II with short loop GE). Gastric resection should, therefore, aim at the reconstruction of the orthograde peristalsis.
对54只雄性Wistar大鼠进行了不同类型的十二指肠旁路手术，包括有或无十二指肠-胃反流的情况。我们的研究结果表明，在伴有反流的十二指肠旁路手术后，消化性吻合口溃疡经常发生。胆汁和胰液的持续反流是胃与小肠吻合口附近溃疡形成的最重要病因。旷置十二指肠的淤滞（输入袢综合征）促进了反流的致溃疡作用。在没有幽门的情况下，反流和淤滞的影响增强，导致溃疡发生率很高（大于90%）。幽门完整时发生率较低。十二指肠-胃反流显著抑制盐酸分泌（p<0.01）；因此，盐酸在大鼠实验性吻合口溃疡的发生中起次要作用。——在考虑预防吻合口溃疡时，这些发现支持避免采用涉及十二指肠旁路和反流的手术技术（短袢胃空肠吻合的毕Ⅱ式手术）的观点。因此，胃切除术应旨在重建顺行蠕动。
