Forssell H, Stenquist B, Lundell L, Olbe L
Dept. of Surgery, Sahlgren's Hospital, Gothenburg University, Sweden.
Scand J Gastroenterol. 1988 Jun;23(5):534-8. doi: 10.3109/00365528809093907.
The variation in basal acid secretion was determined in 10 patients after resection of the esophagus, an operation resulting in a total transection of all vagal nerves to the abdomen. After recording basal acid secretion over a 3-h period, a 15-min modified sham feeding procedure was performed, and the acid output was studied for an additional hour. The mean basal acid output +2 SD was 0.27 mmol/15 min. The difference between the highest and lowest recorded 15-min output--that is, the oscillation of basal acid output--was calculated for each patient. The mean oscillation of basal acid output +2 SD was 0.58 mmol/15 min. Vagal stimulation accomplished by sham feeding produced no significant increase in acid output above this level. The variation in basal acid secretion was also investigated in 20 duodenal ulcer patients after proximal gastric vagotomy. These patients were insulin-negative and remained asymptomatic during a 7- to 10-year follow-up study. Shortly after the vagotomy, measurement of basal acid secretion over 3 h showed a mean basal acid output +2 SD of 0.58 mmol/15 min. The mean oscillation of basal acid output +2 SD was 0.66 mmol/15 min. On the basis of the oscillation in basal acid secretion after complete vagotomy we propose a new criterion for completeness of vagotomy, namely a response to physiologic vagal stimulation which does not exceed the lowest basal level by more than 0.6 mmol/15 min.
对10例食管切除术后的患者进行基础酸分泌变化的测定，该手术导致所有迷走神经完全横断至腹部。在记录3小时的基础酸分泌后，进行15分钟的改良假饲程序，并额外研究1小时的酸排出量。基础酸排出量的平均值+2标准差为0.27 mmol/15分钟。计算每位患者记录的最高和最低15分钟排出量之间的差值，即基础酸排出量的振荡。基础酸排出量的平均振荡+2标准差为0.58 mmol/15分钟。假饲引起的迷走神经刺激并未使酸排出量在此水平之上显著增加。还对20例近端胃迷走神经切断术后的十二指肠溃疡患者进行基础酸分泌变化的研究。这些患者胰岛素阴性，在7至10年的随访研究中无症状。迷走神经切断术后不久，3小时基础酸分泌量的测量显示基础酸排出量的平均值+2标准差为0.58 mmol/15分钟。基础酸排出量的平均振荡+2标准差为0.66 mmol/15分钟。基于完全迷走神经切断术后基础酸分泌的振荡，我们提出了迷走神经切断术完整性的新标准，即对生理性迷走神经刺激的反应不超过最低基础水平0.6 mmol/15分钟以上。
