Becker J M, Kelly K A, Haddad A C, Zinsmeister A R
Surgery. 1983 Jul;94(1):58-64.
Our aim was to develop proximal gastric vagotomy with mucosal antrectomy as an operative approach to duodenal ulcer. We performed mucosal antrectomy in four dogs by excising the antral mucosa via a circular corporal myotomy, removing a circumferential band of corporal seromuscularis, anastomosing the corporal and pyloric mucosas endoantrally, and reapproximating the corporal and antral seromuscularis. Gastric emptying and serum gastrin were assessed before and 4 weeks after operation. A second operation, proximal gastric vagotomy, was then done, and the tests were repeated 4 weeks later. The concentration of gastrin in the serum during fasting was lower after mucosal antrectomy than before operation, as was the postprandial concentration; the values remained low after proximal gastric vagotomy. Gastric emptying of liquids and indigestible solids was unaltered by mucosal antrectomy or mucosal antrectomy plus proximal gastric vagotomy. The emptying of digestible solids was slowed somewhat by mucosal antrectomy to 75% of the control rate, but no further change was found after proximal gastric vagotomy. We concluded that mucosal antrectomy eliminated the gastrin-producing antral mucosa and, in combination with proximal gastric vagotomy, did not greatly alter gastric emptying of liquids or solids. The combined operation might have a role in the surgical treatment of duodenal ulcer.
我们的目标是开发近端胃迷走神经切断术联合黏膜胃窦切除术作为十二指肠溃疡的一种手术方法。我们通过环形胃体肌切开术切除胃窦黏膜，去除胃体浆肌层的环形带，在胃窦内将胃体和幽门黏膜进行端端吻合，并将胃体和胃窦浆肌层重新对合，对4只狗实施了黏膜胃窦切除术。在手术前和术后4周评估胃排空和血清胃泌素水平。然后进行第二次手术，即近端胃迷走神经切断术，并在4周后重复这些测试。黏膜胃窦切除术后空腹时血清胃泌素浓度低于术前，餐后浓度也是如此；近端胃迷走神经切断术后这些值仍保持较低水平。黏膜胃窦切除术或黏膜胃窦切除术加近端胃迷走神经切断术均未改变液体和难消化固体的胃排空。黏膜胃窦切除术使可消化固体的排空略有减慢，降至对照率的75%，但近端胃迷走神经切断术后未发现进一步变化。我们得出结论，黏膜胃窦切除术消除了产生胃泌素的胃窦黏膜，并且与近端胃迷走神经切断术联合使用时，不会显著改变液体或固体的胃排空。这种联合手术可能在十二指肠溃疡的外科治疗中发挥作用。
