Leibur M, Truve R, Sibul U, Roosaar P, Zilmer K
Department of Surgery, Pelgulinna Hospital, Tallinn, Estonia.
Acta Chir Scand. 1990 Sep;156(9):621-4.
Between 1971 and 1986 532 proximal gastric vagotomies were carried out at the Pelgulinna Hospital. The five-year recurrence rate was 5.5% (n = 29). We have studied 40 patients with chronic duodenal ulceration, 20 patients who had effective proximal gastric vagotomy, and seven patients who presented with recurrent ulcers after proximal gastric vagotomy. Patients who had positive Hollander tests after vagotomy, and those with disorders of gastric motility, were excluded. In the group with recurrent ulcers the concentration of neutral mucopolysaccharides in the gastric juice was significantly lower than in the other two groups, and it correlated with the amount of material showing a positive reaction to periodic acid Schiff (PAS) in the gastric mucosa. This group also had significantly higher mean serum gastrin concentrations and mast cell degranulation rates in the mucosa of the fundus and the antrum. We conclude that qualitative changes in the production of gastric mucus lead to defective functioning of the mucosal barrier in patients with recurrent ulcers and may be one of the causes of recurrences.
1971年至1986年间，佩尔古林纳医院共进行了532例近端胃迷走神经切断术。五年复发率为5.5%（n = 29）。我们研究了40例慢性十二指肠溃疡患者，其中20例接受了有效的近端胃迷走神经切断术，7例在近端胃迷走神经切断术后出现复发性溃疡。切断迷走神经后霍兰德试验呈阳性的患者以及有胃动力障碍的患者被排除在外。在复发性溃疡组中，胃液中中性粘多糖的浓度明显低于其他两组，且与胃粘膜中对过碘酸希夫（PAS）呈阳性反应的物质数量相关。该组患者的平均血清胃泌素浓度以及胃底和胃窦粘膜中的肥大细胞脱颗粒率也明显更高。我们得出结论，胃粘液产生的质的变化导致复发性溃疡患者粘膜屏障功能缺陷，可能是复发的原因之一。
