Gobet B, Malikova E, Mignon M, Vatier J
Department of Gastroenterology, Hopital Cantonal, Geneve, Switzerland.
Hepatogastroenterology. 1991 Dec;38(6):522-7.
The results of gastric secretory studies in 192 cases of recurrent ulcer after surgery for duodenal ulcer were analyzed and compared with the secretory data collected in a control group of 74 duodenal ulcer patients who had undergone various forms of gastric surgery, but who did not develop a recurrent ulcer (controls). The patients studied comprised 46 cases of recurrent ulcer after partial gastrectomy, 10 cases of recurrent ulcer after partial gastrectomy and bilateral truncal vagotomy, 56 cases of recurrent ulcer after truncal vagotomy and drainage, 52 cases of recurrent ulcer after highly selective vagotomy, and finally 28 cases in which the recurrent ulcer led to the diagnosis of the Zollinger-Ellison syndrome. The entire study was based upon an analysis of the basal acid output, the response to maximal stimulation by pentagastrin or by histalog and by insulin in the case of previous vagotomy, and finally on an assessment of basal serum gastrin. The analysis has suggested minimal secretory levels with discriminative values useful for the postoperative diagnosis of recurrent ulcer and for an assessment of the completeness of vagotomy (ratio PAO Insulin/PAO pentagastrin or histalog). Moreover, an analysis of various elements of the sequential basal pentagastrin-insulin test permitted us to approach the pathophysiological mechanism responsible for ulcer recurrence, and to identify suitable criteria for selection of the best treatment.
对192例十二指肠溃疡手术后复发性溃疡患者的胃分泌研究结果进行了分析，并与74例接受了各种形式胃手术但未发生复发性溃疡的十二指肠溃疡患者（对照组）收集的分泌数据进行了比较。研究的患者包括46例胃部分切除术后复发性溃疡患者、10例胃部分切除加双侧迷走神经干切断术后复发性溃疡患者、56例迷走神经干切断加引流术后复发性溃疡患者、52例高选择性迷走神经切断术后复发性溃疡患者，最后还有28例复发性溃疡导致佐林格-埃利森综合征诊断的患者。整个研究基于对基础胃酸分泌量、在先前迷走神经切断情况下对五肽胃泌素或组胺的最大刺激反应以及对胰岛素的反应的分析，最后基于对基础血清胃泌素的评估。分析表明，存在最低分泌水平，其鉴别值对复发性溃疡的术后诊断以及迷走神经切断完整性的评估（PAO胰岛素/PAO五肽胃泌素或组胺比值）有用。此外，对连续基础五肽胃泌素-胰岛素试验的各种要素进行分析，使我们能够探讨溃疡复发的病理生理机制，并确定选择最佳治疗方法的合适标准。
