Nagamachi Y, Skoryna S C
Can J Surg. 1977 May;20(3):239-41,243.
Measurement of gastric pepsin and acid secretion was performed before, during and after selective vagotomy with antrectomy (SVA) and Billroth I gastrectomy (B-I) in 20 patients with a duodenal ulcer. Preoperative pepsin concentration increased during operation and decreased gradually 72 hours after SVA and 1 to 3 months after B-I. Although the pepsin concentration decreased substantially, it was never less than 70% of the preoperative level in both groups. Acid concentration decreased immediately after vagotomy in the SVA group and decreased gradually after 72 hours in the B-I group. Although there was a notable increase in the pH in both groups after operation, a pH of 5 was never reached. Decrease in gastric secretory volume (about 50%) was approximately equal in both groups. It appears that any increase in acid secretion occurring after vagotomy or gastrectomy may be sufficient to activate high-and low-pH-acting pepsins. Extravagal and extraantral stimulation of gastric pepsin secretion after operation should be considered an important etiologic factor in the pathogenesis of recurrent ulcer.
对20例十二指肠溃疡患者在选择性迷走神经切断术加胃窦切除术（SVA）和毕罗Ⅰ式胃切除术（B - I）术前、术中及术后进行胃蛋白酶和胃酸分泌测定。术前胃蛋白酶浓度在手术过程中升高，在SVA术后72小时及B - I术后1至3个月逐渐下降。虽然胃蛋白酶浓度大幅下降，但两组均从未低于术前水平的70%。SVA组迷走神经切断术后胃酸浓度立即下降，B - I组术后72小时后逐渐下降。虽然两组术后pH值均显著升高，但从未达到5。两组胃分泌量的减少（约50%）大致相等。似乎迷走神经切断术或胃切除术后发生的任何胃酸分泌增加都可能足以激活高pH值和低pH值作用的胃蛋白酶。术后胃蛋白酶分泌的迷走神经外和胃窦外刺激应被视为复发性溃疡发病机制中的一个重要病因因素。
