Schumpelick V, Begemann F, Peterhoff G, Flashoff D
Langenbecks Arch Chir. 1979;348(1):61-79. doi: 10.1007/BF01240052.
Intragastric concentrations of lysolecithin and bile acids were determined in 112 patients with different types of gastrectomy for peptic ulcer (Billroth I and Billroth II). These values were correlated with intragastric pH, bacterial contamination, gastric mucosal changes and Visick grading. A maximal amount of duodenogastric reflux was found in retrocolic gastrojejunostomy (Billroth II). Smaller, but still highly pathological values were observed in the antecolic gastrojejunostomy with Braun enteroanastomosis as well as in different types of gastroduodenostomy (Billroth I). 70% of the operated stomachs were bacterially contaminated. There was a good correlation between amount of reflux, bacterial contamination and pH-value. Above pH 6 no stomach was sterile, the lysolecithin-concentration increased more than proportional. Gastric mucosal changes correlated closely with the intragastric lysolecithin concentration and the bacterial contamination. There was no correlation between amount of reflux and Visick-grading, no complaints were found in some cases with extreme reflux values as vice versa. The postoperative alkaline reflux gastritis is described, the consequences including the carcinoma of the gastric stump are mentioned. The principles of ulcer surgery are analysed under these aspects.
对112例因消化性溃疡行不同类型胃切除术（毕Ⅰ式和毕Ⅱ式）的患者测定了胃内溶血卵磷脂和胆汁酸的浓度。这些值与胃内pH值、细菌污染、胃黏膜变化及Visick分级相关。在结肠后胃空肠吻合术（毕Ⅱ式）中发现十二指肠胃反流的量最大。在有 Braun 肠吻合术的结肠前胃空肠吻合术以及不同类型的胃十二指肠吻合术（毕Ⅰ式）中观察到的值较小，但仍具有高度病理性。70% 的手术胃存在细菌污染。反流量、细菌污染与pH值之间存在良好的相关性。pH值高于6时，没有胃是无菌的，溶血卵磷脂浓度的增加超过比例。胃黏膜变化与胃内溶血卵磷脂浓度和细菌污染密切相关。反流量与Visick分级之间没有相关性，在一些反流值极高的病例中未发现不适，反之亦然。描述了术后碱性反流性胃炎，并提及了包括残胃癌在内的后果。从这些方面分析了溃疡手术的原则。
