Satake K, Nishiwaki H, Umeyama K
Ann Surg. 1985 Apr;201(4):447-51. doi: 10.1097/00000658-198504000-00008.
The postprandial plasma secretin response was examined in ten normal persons, seven patients with a Billroth I and seven with a Billroth II anastomosis after subtotal gastrectomy, seven with a Roux-en-Y anastomosis, two with an interposed jejunal anastomosis, and five with a modified Child's anastomosis after pancreatoduodenectomy. The postprandial plasma secretin response in patients with Billroth I anastomosis was better than that in patients with a Billroth II anastomosis but was less than that of normal subjects. Although no postprandial secretin response was noted in Roux-en-Y anastomosis after total gastrectomy, a response was seen in patients with the interposed jejunal anastomosis because the digested food passed through the duodenum, but it was less than that for Billroth I and II patients and normal controls. After a modified Child's reconstruction, the postprandial secretin response was similar to that of patients with the Billroth II, which preserved the duodenum. A patient with a modified Child's reconstruction was examined 12 years after surgery and had the same response as other patients with the modified Child's reconstruction and those with a Billroth II anastomosis within 2 months after surgery. After ingestion of hydrochloride solution, the plasma secretin release in patients with a Billroth I and II anastomosis after subtotal gastrectomy and Roux-en-Y anastomosis after total gastrectomy had a better response than after a meal, but this was less than in normal subjects. The authors suggest that careful selection of intestine for the gastrointestinal anastomosis, which contains many secretin secretory cells, is important to obtain endogenous secretin release. For gastrojejunostomy after pancreatoduodenectomy, a method preserving the pylorus is better than the usual gastrojejunostomy because it maintains gastric acid. The ingestion of secretin stimulants, such as hydrochloride, may help to prevent pancreatic dysfunction after gastrectomy and other surgical reconstructions.
对10名正常人、7名单纯胃切除术后行毕罗Ⅰ式吻合术的患者、7名单纯胃切除术后行毕罗Ⅱ式吻合术的患者、7名 Roux-en-Y 吻合术患者、2名间置空肠吻合术患者以及5名胰十二指肠切除术后行改良Child式吻合术的患者进行了餐后血浆促胰液素反应检测。行毕罗Ⅰ式吻合术患者的餐后血浆促胰液素反应优于行毕罗Ⅱ式吻合术的患者，但低于正常受试者。全胃切除术后 Roux-en-Y 吻合术患者未观察到餐后促胰液素反应，而行间置空肠吻合术的患者出现了反应，因为消化食物通过十二指肠，但低于毕罗Ⅰ式和Ⅱ式患者及正常对照。改良Child式重建术后，餐后促胰液素反应与保留十二指肠的毕罗Ⅱ式患者相似。一名行改良Child式重建术的患者在术后12年接受检查，其反应与其他行改良Child式重建术的患者以及术后2个月内行毕罗Ⅱ式吻合术的患者相同。摄入盐酸溶液后，单纯胃切除术后行毕罗Ⅰ式和Ⅱ式吻合术以及全胃切除术后行 Roux-en-Y 吻合术的患者血浆促胰液素释放反应优于进食后，但低于正常受试者。作者认为，仔细选择含有许多促胰液素分泌细胞的肠道进行胃肠吻合术对于获得内源性促胰液素释放很重要。对于胰十二指肠切除术后的胃空肠吻合术，保留幽门的方法比常规胃空肠吻合术更好，因为它能维持胃酸。摄入促胰液素刺激剂，如盐酸，可能有助于预防胃切除术后及其他手术重建后的胰腺功能障碍
