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[术中pH值测定在选择性近端迷走神经切断术中预防胃壁迷走神经切断不全及缺血的应用]

[Intraoperative pH-metry in the prevention of incomplete vagotomy and ischemia of the gastric wall in selective proximal vagotomy].

作者信息

Manevich V L, Kharitonov L G, Magomedov S N

出版信息

Khirurgiia (Mosk). 1989 Oct(10):41-4.

PMID:2593572
Abstract

Experiments were conducted on 14 mongrel dogs to appraise the validity of the results of intraoperative pH-metry in the control of vagotomy completeness depending on the force of pressure exerted on the pH electrode with consideration for the type of a pH catheter used. The level of parietal pH increased with elevating pressure force due to diminished circulation in the gastric wall. The encountered diminution of circulation in the gastric wall after SPV increases still more the pH level and reduces the amplitude of its growth even in areas with maintained parasympathetic innervation with the use of histamine, which raises the probability of incomplete vagotomy. The authors conclude that pH-metry by slight application of the pH electrode to the gastric wall raises the validity of the values recorded and reduces the frequency of incomplete vagotomy in patients operated on in the clinic by 4.7 times. Increase of parietal pH to more than 6.7, irrespective of the force of the exerted pressure, is an indirect sign of ischemia of the gastric wall.

摘要

对14只杂种犬进行了实验,以评估术中pH测定结果在控制迷走神经切断完整性方面的有效性,该评估取决于施加在pH电极上的压力大小,并考虑所使用的pH导管类型。由于胃壁循环减少,壁细胞pH值水平随压力升高而增加。选择性迷走神经切断术后胃壁循环减少,即使在使用组胺维持副交感神经支配的区域,也会进一步提高pH值水平并降低其增长幅度,这增加了迷走神经切断不完全的可能性。作者得出结论,将pH电极轻轻应用于胃壁进行pH测定可提高记录值的有效性,并将临床手术患者迷走神经切断不完全的发生率降低4.7倍。无论施加压力的大小如何,壁细胞pH值升高至超过6.7是胃壁缺血的间接征象。

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