Hartley M N, Mackie C R
University Department of Surgery, Royal Liverpool Hospital, UK.
Br J Surg. 1991 Jan;78(1):24-7. doi: 10.1002/bjs.1800780109.
Gastric adaptive relaxation is reported to be impaired after vagotomy. This abnormality has been implicated in the pathogenesis of postvagotomy symptoms, but no association has previously been demonstrated between the two. Gastric adaptive relaxation was measured in 15 healthy volunteers and 33 patients more than 1 year after highly selective vagotomy or truncal vagotomy and drainage. Seventeen patients were asymptomatic. The remainder were symptomatic including seven patients with persistent diarrhoea. Fasted subjects were intubated with a Ryle's tube containing a pressure microtransducer within a flaccid (800 ml) plastic bag. Gastric corpus-fundus pressure was recorded during distension of the bag with air (15 ml/s) over 30 s. Pressure indices were derived from the areas under the pressure curves. Median (range) pressure indices were: healthy volunteers 12.7 (7.5-17.1) cmH2O, highly selective vagotomy 14.0 (9.8-15.9) cmH2O (n.s.), truncal vagotomy and drainage 14.5 (8.6-26.8) cmH2O (P = 0.04). All patients with diarrhoea had abnormally high pressure indices (P less than 0.001). Pressure indices in all other patient groups were within the normal range. We conclude that gastric adaptive relaxation remains abnormal in patients with postvagotomy diarrhoea but not in those who are asymptomatic or who have other symptoms.
据报道，迷走神经切断术后胃适应性舒张功能受损。这种异常现象被认为与迷走神经切断术后症状的发病机制有关，但此前尚未证实两者之间存在关联。对15名健康志愿者以及33名接受高选择性迷走神经切断术或迷走神经干切断术加引流术后1年以上的患者进行了胃适应性舒张功能测量。17名患者无症状。其余患者有症状，包括7名持续性腹泻患者。让禁食的受试者插入一根带有压力微型传感器的赖尔氏管，该传感器置于一个松弛的（800毫升）塑料袋内。在30秒内用空气（15毫升/秒）使袋子膨胀的过程中记录胃体-胃底压力。压力指数由压力曲线下的面积得出。中位数（范围）压力指数为：健康志愿者12.7（7.5 - 17.1）厘米水柱，高选择性迷走神经切断术患者14.0（9.8 - 15.9）厘米水柱（无显著差异），迷走神经干切断术加引流患者14.5（8.6 - 26.8）厘米水柱（P = 0.04）。所有腹泻患者的压力指数异常高（P < 0.001）。所有其他患者组的压力指数在正常范围内。我们得出结论，迷走神经切断术后腹泻患者的胃适应性舒张功能仍异常，但无症状或有其他症状的患者则不然。
