Gullo L, Priori P, Pezzilli R, Biliotti G, Mattioli G, Barbara L
Unit for the Study of Pancreatic Disease, University of Bologna, Italy.
Gastroenterology. 1988 Feb;94(2):428-33. doi: 10.1016/0016-5085(88)90432-5.
We have studied the pancreatic secretory response to a normal meal in 5 subjects with an external drainage of the main pancreatic duct carried out after biliary tract surgery. Pancreatic juice was collected at 60-min intervals from 10 AM to 7 PM, starting 2 h before and ending 7 h after lunch, and was analyzed for volume, bicarbonate content, and protein content. Large doses of pancreatic extract were given between and during meals. Both bicarbonate and protein output increased rapidly after the beginning of the meal and the increase persisted, with minor fluctuations, for the entire 7-h study period between lunch and dinner. The peak postprandial bicarbonate and protein outputs were higher (on average by 20% and 26%, respectively) than bicarbonate and protein outputs induced by exogenous infusion of submaximal doses of secretin and cerulein. The profile and magnitude of the bicarbonate secretory pattern elicited by food were not substantially different from those of protein secretion. In an additional patient who had undergone a duodenocephalopancreatectomy plus two-thirds distal gastrectomy before the study, the pancreatic response to meals showed an initial phase characterized by an increase in pancreatic secretion during the first postprandial hour followed by a tendency to decrease in the subsequent 2 h, and a later phase (from the fourth postprandial hour to the end of the study) characterized by a more marked and more persistent increase in pancreatic secretion than occurred in the initial 3 h. These data indicate that (a) the pancreatic secretory response to ordinary meals is much more prolonged than is generally believed. The late phase of the response is not dependent on gastric emptying of food into the duodenum, but is probably related to the arrival of chyme in the distal ileum. (b) The pancreatic secretory response to a normal meal is quantitatively slightly higher than that produced by exogenous pancreatic stimulation with submaximal doses of secretin and cerulein. (c) The pattern of postprandial bicarbonate secretion is similar to that for protein.
我们研究了5例在胆道手术后进行主胰管外引流的患者对正常餐食的胰腺分泌反应。从上午10点至下午7点，每隔60分钟收集一次胰液，从午餐前2小时开始，至午餐后7小时结束，并对胰液的体积、碳酸氢盐含量和蛋白质含量进行分析。在进餐期间及两餐之间给予大剂量的胰腺提取物。进餐开始后，碳酸氢盐和蛋白质的分泌量迅速增加，并在整个7小时的研究期间（从午餐到晚餐）持续增加，仅有轻微波动。餐后碳酸氢盐和蛋白质分泌的峰值高于（平均分别高出20%和26%）由亚最大剂量的促胰液素和雨蛙肽外源性输注诱导的碳酸氢盐和蛋白质分泌量。食物引起的碳酸氢盐分泌模式的特征和幅度与蛋白质分泌的特征和幅度没有实质性差异。在另外一名在研究前接受了十二指肠胰头切除术加三分之二远端胃切除术的患者中，胰腺对餐食的反应显示出一个初始阶段，其特征是餐后第一小时胰腺分泌增加，随后2小时有下降趋势，以及一个后期阶段（从餐后第四小时至研究结束），其特征是胰腺分泌的增加比最初3小时更为显著和持久。这些数据表明：(a)胰腺对普通餐食的分泌反应比一般认为的要长得多。反应的后期阶段不依赖于食物排空至十二指肠，而可能与食糜到达回肠末端有关。(b)胰腺对正常餐食的分泌反应在数量上略高于用亚最大剂量的促胰液素和雨蛙肽进行外源性胰腺刺激所产生的反应。(c)餐后碳酸氢盐分泌模式与蛋白质分泌模式相似。
