Shibata C, Sasaki I, Naito H, Ohtani N, Matsuno S
First Department of Surgery, Tohoku University School of Medicine, Sendai, Japan.
J Am Coll Surg. 1995 Dec;181(6):545-51.
In the present study we evaluated gastrointestinal motility after gastrectomy of a new pylorus-preserving technique that is becoming a popular operation for early stage carcinoma of the stomach.
Using strain-gauge force transducers we studied gastrointestinal motility in control dogs, dogs after pylorus-preserving gastrectomy, and dogs after conventional distal gastrectomy with Billroth I reconstruction. Dogs with gastrectomy were reoperated upon after recording motility patterns, and the effect of vagal denervation of the gastric remnant on motility was investigated. Overall motility pattern, length of the digestive phase in the jejunum, and interval of the interdigestive phase III contractions were studied and compared among the three groups.
In dogs after gastrectomy without vagal denervation, the regular occurrence of interdigestive phase III contractions from the gastric remnant to the jejunum was identified. In dogs after gastrectomy with vagal denervation, however, no apparent interdigestive phase III contractions were observed in the gastric remnant. The duration of the digestive phase in the jejunum, which correlates with postprandial gastric emptying, was not different between the control dogs and the dogs having pylorus-preserving gastrectomy. However, this duration was significantly shorter in dogs having conventional distal gastrectomy compared with the control dogs, not only before but after vagal denervation.
These results indicate that the postoperative motor function after pylorus-preserving gastrectomy may be superior to that after conventional distal gastrectomy with Billroth I reconstruction.
在本研究中，我们评估了一种新的保留幽门技术胃切除术后的胃肠动力，该技术正成为早期胃癌的一种常用手术方式。
我们使用应变片力传感器，对对照犬、保留幽门胃切除术后的犬以及采用毕罗一式重建的传统远端胃切除术后的犬的胃肠动力进行了研究。记录动力模式后，对接受胃切除术的犬再次进行手术，并研究胃残端迷走神经切断对动力的影响。研究并比较了三组的整体动力模式、空肠消化期长度以及消化间期III期收缩的间隔时间。
在未进行迷走神经切断的胃切除术后的犬中，发现从胃残端到空肠有规律地出现消化间期III期收缩。然而，在进行了迷走神经切断的胃切除术后的犬中，胃残端未观察到明显的消化间期III期收缩。与餐后胃排空相关的空肠消化期持续时间，在对照犬和保留幽门胃切除术后的犬之间没有差异。然而，与对照犬相比，采用传统远端胃切除术的犬的这一持续时间明显更短，无论是在迷走神经切断前还是切断后。
这些结果表明，保留幽门胃切除术后的术后运动功能可能优于采用毕罗一式重建的传统远端胃切除术后的运动功能。
