Misumi A, Harada K, Mizumoto S, Yoshinaka I, Maeda M, Nakashima Y, Ogawa M
Second Department of Surgery, Kumamoto University Medical School, Japan.
Nihon Geka Gakkai Zasshi. 1991 Sep;92(9):1175-9.
We investigated the effect of gastrectomy on the digestive system in 87 postoperative long-term survivors under test meal or egg yolk load. After test meal, gastrin and secretin responses were decreased in each of groups of proximal gastrectomy (PG), distal gastrectomy with Billroth-I (DG-B1), that with Billroth-II (DG-B2), total gastrectomy with interposition (TG-I), and that with Roux-Y (TG-RY). However, sufficient acid-secretors after partial gastrectomy showed secretin responses comparable to controls. Furthermore, cases of total gastrectomy given betain-hydrochloride with test meal increased secretin responses. Serum glucose response was higher in the TG-RY group while insulin response was high in the TG-RY and DG-B2 groups, compared with controls. GLI response was high in all groups compared with controls. Postgastrectomy gallstone occurred in 11.6%. Yolk-induced contraction of the gallbladder was decreased, and CCK release increased, for several years postoperatively. Gallbladder contraction with CCK was reduced for one year postoperatively. The contraction was reduced in persons with gallstone than those without it. This study shows that the digestive function after gastrectomy depends on acidification and duodenal passage of food, and that reduced contraction with CCK plays an important role in hypokinesis of the gallbladder.
我们在87例术后长期存活者中，于试餐或蛋黄负荷情况下，研究了胃切除术对消化系统的影响。试餐后，近端胃切除术（PG）组、毕罗一式远端胃切除术（DG-B1）组、毕罗二式远端胃切除术（DG-B2）组、间置空肠全胃切除术（TG-I）组和Roux-Y全胃切除术（TG-RY）组的胃泌素和促胰液素反应均降低。然而，部分胃切除术后胃酸分泌充足者的促胰液素反应与对照组相当。此外，给予盐酸甜菜碱试餐的全胃切除病例促胰液素反应增加。与对照组相比，TG-RY组的血清葡萄糖反应较高，而TG-RY组和DG-B2组的胰岛素反应较高。与对照组相比，所有组的胃肠肽释放抑制因子（GLI）反应均较高。胃切除术后胆结石发生率为11.6%。术后数年，蛋黄引起的胆囊收缩减弱，胆囊收缩素（CCK）释放增加。术后1年内，CCK引起的胆囊收缩减弱。有胆结石者的胆囊收缩比无胆结石者减弱。本研究表明，胃切除术后的消化功能取决于食物的酸化和十二指肠通过情况，并且CCK引起的胆囊收缩减弱在胆囊运动功能减退中起重要作用。
