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大鼠胃窦部断面性消化性溃疡与胃窦-胃底再吻合术(可能的胃窦-胃底神经内分泌中心的表现)

[Post-sectional antral peptic ulcer and antrofundic re-anastomosis in rats (manifestation of a probable antrofundic neuroendocrine center)].

作者信息

Tiscornia O M, De Paula J A, Celener D, Schiffrin E, Nakasato O, Cresta M A, Waisman H, Bustos Fernández L

机构信息

Fundación Dr. J. Pérez Companc, Buenos Aires, Argentina.

出版信息

Acta Gastroenterol Latinoam. 1988;18(1):3-21.

PMID:3066090
Abstract

The antrum-fundic section and re-anastomosis (AESR), liberates, in Wistar male rats, genuine antral peptic ulcers. They start within 20 days. They are progressive evolution, penetrating into all gastric walls. Between 7 and 8 months, they involve near organs (spleen, liver, pancreas) and produce a great inflammatory reaction of the peripancreatic ganglions. The antral peptic ulcer is induced if the gastric lesser curvature's nerves are sectioned and a concomitant pyloroplasty is done or not. The gastric hemisection, if anterior or posterior, break out the peptic ulcer only on the same side of the antrum-fundic interruption. In all this situations, except in cases of concomitant pyloroplasty, it is proved a pronounced and significantly increase of the gastric (g/kg), but not pancreatic index. In the AFSR series with nervous section on the lesser curvature and without pyloroplasty, the percentage of antral peptic ulcers in 56%. It is postulated the probably existence, at an antrum-fundic level, of a neuroendocrine center. Its nullification or disturbance by the section and re-anastomosis procedure could generate the antral ulcer and other histologic changes (increase of the "G" cells, hyperplasia of the parietal, ECL and "A like" cells) by one or various hypothetical ways: 1. Direct action, nullifying the normal blocking function of somatostative over the "G" cells and or parietal cells. 2. Disturbing or nullifying the motor pump effect of the gastric antrum, and on this way, enhancing the duodenum-gastric reflux with all know deleterious effects of the bile in the antrum particularly in an acid milieu. 3. Modifying, in the opposite direction, the sensitivity by one hand, of the "G" cells mass and by the other one, of the parietal, ECL and "A like" cells. The depression of the fundic sensitivity will induce the hyperplasia of the "G" cells, the hypersecretion of gastrin and, "a posteriori", all the secretory effects and trophic characteristic of it. 4. Disturbing the prostaglandins secretion, perhaps through a deficit of the nervous innervation, with the resulting epiphenomenon of a cytoprotection deficit mediated through the mucus and bicarbonate production. It is probably that the proposed physiopathogenic mechanism are associated and that the final result, the antral peptic ulcer is the consequence of an increase of the aggressive factors (acid, bile) and a concomitant depression of the defensive factors (cytoprotection), starting normally by the prostaglandins through the mucus and bicarbonate secretion.

摘要

胃窦-胃底切断与再吻合术(AESR)可在雄性Wistar大鼠身上引发真正的胃窦部消化性溃疡。这些溃疡在20天内开始出现。它们呈进行性发展,可穿透所有胃壁。在7至8个月时,会累及附近器官(脾脏、肝脏、胰腺),并引发胰周神经节的强烈炎症反应。如果切断胃小弯神经并同时或不进行幽门成形术,就会诱发胃窦部消化性溃疡。胃半切术,无论在前侧还是后侧,仅在胃窦-胃底切断的同侧引发消化性溃疡。在所有这些情况下,除了同时进行幽门成形术的病例外,均证实胃(g/kg)指数显著且明显升高,但胰腺指数无变化。在胃小弯神经切断且未进行幽门成形术的AESR系列中,胃窦部消化性溃疡的发生率为56%。推测在胃窦-胃底水平可能存在一个神经内分泌中心。切断与再吻合手术使其功能丧失或紊乱,可能通过以下一种或多种假设方式引发胃窦溃疡及其他组织学变化(“G”细胞增多、壁细胞、肠嗜铬样细胞和“A样”细胞增生):1. 直接作用,使生长抑素对“G”细胞和/或壁细胞的正常阻断功能丧失。2. 干扰或消除胃窦的运动泵作用,从而增强十二指肠-胃反流,胆汁在胃窦中的所有已知有害作用,尤其是在酸性环境中。3. 从相反方向改变“G”细胞群以及壁细胞、肠嗜铬样细胞和“A样”细胞的敏感性。胃底敏感性降低会导致“G”细胞增生、胃泌素分泌过多,以及随之而来的所有分泌效应和营养特性。4. 可能通过神经支配不足干扰前列腺素分泌,导致通过黏液和碳酸氢盐产生介导的细胞保护作用缺失这一附带现象。推测所提出的病理生理机制相互关联,最终结果即胃窦部消化性溃疡是攻击因子(酸、胆汁)增加以及防御因子(细胞保护作用)同时降低的结果,通常始于前列腺素通过黏液和碳酸氢盐分泌减少。

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