Rieu P N, Jansen J B, Joosten H J, Biemond I, Yap S H, Lamers C B
Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.
Surgery. 1989 Mar;105(3):331-6.
In order to delineate the role of enterogastric reflux in changes of postoperative gastric secretory functions, 22 patients with peptic ulcers, who were randomly assigned to partial gastrectomy without vagotomy with either Billroth II or Roux-en-Y anastomosis, were prospectively studied before and 6 months after surgery. Preoperatively, there were no significant differences in gastric secretory functions between the two groups of 11 patients. Postoperatively, median fasting bile acids in the stomach increased in the Billroth II patients from 0.35 to 16.10 mumol/hr (p less than 0.01), but significantly decreased in the Roux-en-Y patients from 0.30 to 0.10 mumol/hr (p less than 0.05), which indicated adequate prevention of enterogastric reflux after the Roux-en-Y procedure. Gastrectomy resulted in significant reductions of median values of basal acid output (4.6 vs 0.6 mmol/hr, p less than 0.01, and 4.2 vs 0.4 mmol/hr, p = 0.02), peak acid output (31.6 vs 4.2 mmol/hr, p less than 0.01, and 38.7 vs 4.5 mmol/hr, p less than 0.01), serum pepsinogen A (121 vs 86 micrograms/L, p less than 0.01, and 92 vs 45 micrograms/L, p less than 0.01), meal-stimulated serum gastrin secretion (1472 vs 199 pM.60 min, p less than 0.0001, and 1017 vs 199 pM.60 min, p less than 0.0001) in the patients with Billroth II and Roux-en-Y anastomosis, respectively. There were, however, no significant differences in gastric secretory parameters between the two groups when studied 6 months after surgery. Therefore it is concluded that after gastrectomy, enterogastric reflux does not affect the secretory function of the gastric remnant within the first 6 months after surgery.
为了阐明肠胃反流在术后胃分泌功能变化中的作用，对22例消化性溃疡患者进行了前瞻性研究，这些患者被随机分配接受未行迷走神经切断术的部分胃切除术，采用毕罗Ⅱ式或 Roux-en-Y 吻合术，并在手术前和术后6个月进行观察。术前，两组11例患者的胃分泌功能无显著差异。术后，毕罗Ⅱ式患者胃内空腹胆汁酸中位数从0.35微摩尔/小时增加到16.10微摩尔/小时（p<0.01），而Roux-en-Y患者则从0.30微摩尔/小时显著降至0.10微摩尔/小时（p<0.05），这表明Roux-en-Y手术后能有效预防肠胃反流。胃切除术导致毕罗Ⅱ式和Roux-en-Y吻合术患者的基础胃酸分泌量中位数显著降低（分别为4.6对0.6毫摩尔/小时，p<0.01；4.2对0.4毫摩尔/小时，p = 0.02），最大胃酸分泌量（分别为31.6对4.2毫摩尔/小时，p<0.01；38.7对4.5毫摩尔/小时，p<0.01），血清胃蛋白酶原A（分别为121对86微克/升，p<0.01；92对45微克/升，p<0.01），餐后刺激血清胃泌素分泌（分别为1472对199皮摩尔/60分钟，p<0.0001；1017对199皮摩尔/60分钟，p<0.0001）。然而，术后6个月研究时，两组之间的胃分泌参数无显著差异。因此得出结论，胃切除术后，肠胃反流在术后6个月内不影响残余胃的分泌功能。
