Richter H M, Kelly K A, Go V L
Surgery. 1987 May;101(5):623-31.
The aim of this study was to determine whether mucosal antrectomy, which preserves antropyloric motility, would enhance the antiulcer properties of proximal gastric vagotomy (PGV). Hydrochloric acid and gastrin secretion were studied in five dogs before and after PGV and mucosal antrectomy, while the response to the Mann-Williamson operation (an ulcer-producing operation) was evaluated in four control dogs with intact stomachs, five dogs with PGV alone, and six dogs with PGV plus mucosal antrectomy. Proximal gastric vagotomy and mucosal antrectomy decreased mean +/- SEM basal and pentagastrin-stimulated acid secretion from 4.3 +/- 1.3 to 0.4 +/- 0.3 mEq/hr and from 21 +/- 0.7 to 7.4 +/- 1.8 mEq/hr, respectively (p less than 0.05). Basal plasma gastrin was altered little by the operation (68 +/- 9.7 pg/ml before, 58 +/- 11 pg/ml after; p greater than 0.05) but the 4-hour integrated plasma gastrin response to a 200 gm meat meal decreased from 13 +/- 1.8 to 3.3 +/- 0.7 ng X min/ml (p less than 0.05). Only one of six dogs with mucosal antrectomy and PGV developed peptic ulcer after the Mann-Williamson operation, whereas four of five with PGV alone and three of four controls developed ulcers (p less than 0.05, PGV alone versus PGV and mucosal antrectomy). In conclusion, PGV and mucosal antrectomy decreased acid secretion and postcibal gastrin response and provided greater protection against peptic ulcer than PGV alone.
本研究的目的是确定保留胃窦蠕动的黏膜胃窦切除术是否会增强近端胃迷走神经切断术（PGV）的抗溃疡特性。在进行PGV和黏膜胃窦切除术之前及之后，对5只狗的盐酸和胃泌素分泌情况进行了研究，同时对4只胃完整的对照狗、5只仅接受PGV的狗以及6只接受PGV加黏膜胃窦切除术的狗进行了Mann-Williamson手术（一种致溃疡手术）后的反应评估。近端胃迷走神经切断术和黏膜胃窦切除术使平均±标准误基础胃酸分泌和五肽胃泌素刺激的胃酸分泌分别从4.3±1.3降至0.4±0.3毫当量/小时以及从21±0.7降至7.4±1.8毫当量/小时（p<0.05）。基础血浆胃泌素水平在术后变化不大（术前为68±9.7皮克/毫升，术后为58±11皮克/毫升；p>0.05），但对200克肉餐的4小时血浆胃泌素综合反应从13±1.8降至3.3±0.7纳克·分钟/毫升（p<0.05）。在接受Mann-Williamson手术后，6只接受黏膜胃窦切除术和PGV的狗中只有1只发生了消化性溃疡，而5只仅接受PGV的狗中有4只以及4只对照狗中有3只发生了溃疡（p<0.05，仅PGV组与PGV加黏膜胃窦切除术组相比）。总之，PGV和黏膜胃窦切除术降低了胃酸分泌和餐后胃泌素反应，并且比单独的PGV提供了更强的抗消化性溃疡保护作用。
