Takahashi T, Yamamura T, Yokoyama E, Kantoh M, Kusunoki M, Ishikawa Y, Utsunomiya J
Am J Gastroenterol. 1986 Aug;81(8):672-7.
Contractile motility of the gallbladder was compared using a real-time ultrasonography in 13 patients with gastric ulcer and 31 patients with gastric cancer who had undergone either subtotal or total gastrectomy within 1 month previously. Contractile motility of the gallbladder after oral administration of dried egg yolk (Daiyan, Maruishi, Osaka), which was slightly but not significantly reduced in patients with gastric ulcer, was remarkedly impaired in patients with gastric cancer who had either subtotal or total gastrectomy including radical lymph node dissection. Especially, maximum contractile rate after Daiyan in Billroth II patients was significantly reduced than that of Billroth I patients. Intramuscular injection of naloxone (0.4 mg), which had no effects on contractions after Daiyan in healthy subjects, significantly improved the hypomotility in response to Daiyan in these gastric cancer patients. It was suggested, therefore, that the possible roles of various anatomical and mechanical changes resulting from gastrectomy including vagotomy and sympathectomy, and in particular exclusion of duodenum from digestive circuits and relative or absolute excess of endogenous opioids, were involved in the control of the gallbladder motility within 1 month after gastrectomy including lymphadenectomy.
对13例胃溃疡患者和31例胃癌患者进行了实时超声检查，比较胆囊的收缩运动。这些患者均在1个月内接受了胃大部切除术或全胃切除术。口服干蛋黄（代盐，丸石制药，大阪）后，胃溃疡患者胆囊收缩运动略有下降，但无显著差异，而接受胃大部切除术或全胃切除术（包括根治性淋巴结清扫术）的胃癌患者胆囊收缩运动明显受损。特别是，毕罗Ⅱ式手术患者口服代盐后的最大收缩率明显低于毕罗Ⅰ式手术患者。肌肉注射纳洛酮（0.4毫克）对健康受试者口服代盐后的胆囊收缩无影响，但能显著改善这些胃癌患者口服代盐后的运动功能减退。因此，提示胃切除术（包括迷走神经切断术和交感神经切除术）引起的各种解剖和机械改变，特别是十二指肠从消化回路中排除以及内源性阿片类物质相对或绝对过量，可能参与了包括淋巴结清扫术在内的胃切除术后1个月内胆囊运动的控制。
