Shan Yan-Shen, Hsieh Yu-Hsiang, Yao Wei-Jen, Tsai Mei-Ling, Lin Pin-Wen
Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138, Sheng-Li Road, Tainan, 70428, Taiwan.
World J Surg. 2007 Aug;31(8):1606-15. doi: 10.1007/s00268-007-9100-9.
Delayed gastric emptying (DGE) is the major morbidity after pylorus-preserving pancreaticoduodenectomy (PPPD). Gastroscintigraphy was used to characterize food distribution in the proximal and distal stomach during emptying.
Between October 2000 and June 2003, 20 healthy volunteers and 23 PPPD patients underwent single-phase gastric emptying scintigraphy 14 days after surgery. Scintigraphic studies of the stomach were divided into proximal and distal regions, and the ratio of proximal to distal radiation counts (P/DR) was plotted. Momentary monitor-displayed images were compared to evaluate meal distribution during emptying.
There were 21 eligible patients, 12 without symptoms of DGE (sDGE-) and 9 with symptoms of DGE (sDGE+). In healthy volunteers the mean P/DR value was maintained at a level of > or = 2.5, and momentary images showed dilated proximal and constricted distal stomach throughout meal emptying. In both the solid and liquid phase tests, the average P/DR value for sDGE- patients was slightly lower than that for healthy volunteers, and momentary images showed early emptying of the solid meal. The mean P/DR value for sDGE+ patients was abnormally low and remained constant throughout the assessment. Momentary images showed significant dilatation of the distal stomach, with constant full size. The odds ratio for the change in P/DR per minute decreased after surgery, especially in sDGE+ patients, indicating a loss of contractility of the distal stomach. At the 6-month follow-up, the P/DR values exhibited a normal decreasing trend but were lower for sDGE+ patients than for healthy volunteers.
The P/DR curve provides new insight into normal and pathological gastric function. After surgery, temporary loss of contractility of the distal stomach causes symptoms of DGE.
胃排空延迟（DGE）是保留幽门胰十二指肠切除术（PPPD）后的主要并发症。采用胃闪烁扫描术来描述排空过程中食物在胃近端和远端的分布情况。
2000年10月至2003年6月期间，20名健康志愿者和23例PPPD患者在术后14天接受了单相胃排空闪烁扫描术。对胃的闪烁扫描研究分为近端和远端区域，并绘制近端与远端放射性计数比值（P/DR）。比较瞬间监测显示的图像以评估排空期间的食物分布。
有21例符合条件的患者，12例无DGE症状（sDGE-），9例有DGE症状（sDGE+）。在健康志愿者中，平均P/DR值维持在≥2.5的水平，瞬间图像显示在整个进餐排空过程中胃近端扩张而远端收缩。在固体和液体相试验中，sDGE-患者的平均P/DR值略低于健康志愿者，瞬间图像显示固体餐早期排空。sDGE+患者的平均P/DR值异常低且在整个评估过程中保持不变。瞬间图像显示胃远端显著扩张，大小恒定。术后每分钟P/DR变化的优势比下降，尤其是在sDGE+患者中，表明胃远端收缩力丧失。在6个月的随访中，P/DR值呈现正常下降趋势，但sDGE+患者低于健康志愿者。
P/DR曲线为正常和病理性胃功能提供了新的见解。术后，胃远端收缩力的暂时丧失导致DGE症状。
