Tangoku A, Nishikawa M, Adachi A, Suzuki T
Department of Surgery II, Yamaguchi University School of Medicine, Ube, Japan.
Ann Surg. 1991 Jul;214(1):56-60. doi: 10.1097/00000658-199107000-00009.
Plasma gastrin and cholecystokinin (CCK) responses were measured after a pancreatoduodenectomy (PD) using the Billroth-I type reconstruction combined with distal partial gastrectomy (standard PD) and combined with preservation of the pylorus and the duodenal bulb (PPPD). Six unoperated patients, 4 men and 2 women, were studied as control subjects. Basal plasma levels of gastrin were significantly higher in controls than in patients who had a standard PD (p less than 0.05) and gastrin responses to a meal were also blunted in these patients. In contrast basal and postprandial levels of gastrin after PPPD were significantly higher than these found in patients with standard PD (p less than 0.05). Postprandial gastrin response after PPPD were similar in pattern to these found in controls. Integrated gastrin release after PPPD was less than that of the control but was significantly greater than that in patients with standard PD. Basal plasma levels of CCK in the patients after the standard PD were significantly lower than in controls and significantly higher postprandial levels of CCK were found after PPPD compared to standard PD (p less than 0.05). However integrated CCK from 0 to 120 minutes were not significantly different between PPPD and standard PD groups. Based on these observations concerning hormonal release of gastrin and CCK, preservation of the stomach and the duodenal bulb appears to be a more physiologic reconstructive procedure than the standard PD. In addition the operation probably has more beneficial effect on the injured pancreas in time.
采用毕Ⅰ式重建联合远端部分胃切除术（标准胰十二指肠切除术）以及联合保留幽门和十二指肠球部（保留幽门和十二指肠球部的胰十二指肠切除术）的方法，在胰十二指肠切除术后测量血浆胃泌素和胆囊收缩素（CCK）反应。选取6例未接受手术的患者（4例男性，2例女性）作为对照对象进行研究。对照组的基础血浆胃泌素水平显著高于接受标准胰十二指肠切除术的患者（p<0.05），并且这些患者对进餐的胃泌素反应也减弱。相比之下，保留幽门和十二指肠球部的胰十二指肠切除术后的基础和餐后胃泌素水平显著高于标准胰十二指肠切除术患者（p<0.05）。保留幽门和十二指肠球部的胰十二指肠切除术后的餐后胃泌素反应模式与对照组相似。保留幽门和十二指肠球部的胰十二指肠切除术后的胃泌素综合释放量低于对照组，但显著高于标准胰十二指肠切除术患者。标准胰十二指肠切除术后患者的基础血浆CCK水平显著低于对照组，与标准胰十二指肠切除术相比，保留幽门和十二指肠球部的胰十二指肠切除术后餐后CCK水平显著升高（p<0.05）。然而，保留幽门和十二指肠球部的胰十二指肠切除术组与标准胰十二指肠切除术组在0至120分钟的CCK综合释放量无显著差异。基于这些关于胃泌素和CCK激素释放的观察结果，保留胃和十二指肠球部似乎是一种比标准胰十二指肠切除术更符合生理的重建手术。此外，该手术可能对损伤的胰腺在短期内有更有益的影响。
