Rothmund M, Grimm W, Benken U, Jennewein H M
Chirurg. 1978 Sep;49(9):567-75.
The influence of selective proximal vagotomy (SPV) and of an additional pyloroplasty (Heineke-Mikulicz) on gastric emptying, acid and gastrin secretion, and duodenogastric reflux was examined experimentally. After SPV, gastric emptying of fluids and a solid meal was significantly faster than before surgery. An additional pyloroplasty did not influence gastric emptying time significantly. Gastrin secretion after stimulation with a protein-rich meal increased significantly after SPV and did not change much after pyloroplasty was added. It can be concluded that increased gastrin secretion after SPV is not a result of delayed emptying. Pentagastrin-stimulated acid secretion was reduced by 70% after SPV and after additional pyloroplasty as well. The results show that reduced acid secretion after SPV causes the rise in serum gastrin levels. After SPV no duodenogastric reflux occurred. An additional pyloroplasty led to a significant rise of bromsulphaleine used as a marker for bile in gastric aspirate. Obviously destruction of the pylorus leads to a loss of its antireflux function. This leads to an antral gastritis which after 3 months is of chronic-atrophic type. A stimulation of gastrin output by bile could not be demonstrated. It can be concluded that after SPV gastric emptying is not delayed. A pyloroplasty does not affect gastrin release and acid secretion. Drainage procedures together with SPV should be avoided to prevent duodenogastric reflux and antral gastritis.
通过实验研究了选择性近端迷走神经切断术（SPV）以及附加幽门成形术（海涅克-米库利奇术式）对胃排空、胃酸和胃泌素分泌以及十二指肠-胃反流的影响。SPV术后，液体和固体食物的胃排空明显比手术前加快。附加幽门成形术对胃排空时间无显著影响。富含蛋白质的餐食刺激后，SPV术后胃泌素分泌显著增加，附加幽门成形术后变化不大。可以得出结论，SPV术后胃泌素分泌增加并非排空延迟所致。SPV术后以及附加幽门成形术后，五肽胃泌素刺激的胃酸分泌均减少了70%。结果表明，SPV术后胃酸分泌减少导致血清胃泌素水平升高。SPV术后未发生十二指肠-胃反流。附加幽门成形术导致用作胃抽吸物中胆汁标志物的磺溴酞钠显著升高。显然，幽门的破坏导致其抗反流功能丧失。这会导致胃窦炎，3个月后为慢性萎缩型。未证实胆汁能刺激胃泌素分泌。可以得出结论，SPV术后胃排空未延迟。幽门成形术不影响胃泌素释放和胃酸分泌。应避免与SPV一起进行引流手术，以防止十二指肠-胃反流和胃窦炎。
